Surveyor Minimum Qualifications Test (SMQT) — Questions and Answers

Question 1: What does PRN (pro re nata) medication monitoring require in a long-term care survey context?

PRN medications may be given freely without documentation
PRN orders must have a documented indication, and use must be monitored for effectiveness and appropriateness (Correct answer)
PRN medications cannot be psychotropic drugs
PRN orders expire after 30 days automatically

Correct answer: PRN orders must have a documented indication, and use must be monitored for effectiveness and appropriateness

Surveyors verify that PRN medications have a clear indication in the order, are documented each time given, and are reviewed for efficacy and ongoing appropriateness.

Question 2: Under CMS guidelines, which survey task involves reviewing a sample of residents' comprehensive assessments and care plans?

Beneficiary protection notification review
Resident sample selection and care planning (Correct answer)
Closed record review
Resident council interview

Correct answer: Resident sample selection and care planning

The resident sample task includes reviewing MDS assessments and care plans to evaluate individualized care.

Question 3: A surveyor reviewing Quality of Life documentation should expect to find evidence that the plan does which of the following regarding person-centered service plans?

Develops plans solely based on clinical assessment without enrollee input
Updates plans only when the enrollee's condition deteriorates
Incorporates enrollee preferences, goals, and strengths (Correct answer)
Creates generic plans based on diagnosis categories

Correct answer: Incorporates enrollee preferences, goals, and strengths

Person-centered service plans must reflect the enrollee's own preferences, goals, and strengths, not just clinical findings or standardized templates.

Question 4: According to federal regulations at 42 CFR §483.90(d), a facility's resident call system must be accessible from which specific locations?

The physical therapy room and all facility exits.
The shower, activity room, and main entrance.
Each resident's bed and toilet. (Correct answer)
Each resident's bed and the common dining areas.

Correct answer: Each resident's bed and toilet.

The regulation at 42 CFR §483.90(d)(3) explicitly states that the resident call system must be equipped to receive resident calls from each resident's bed and toilet.

Question 5: Which two purposes does surveying serve?

To determine longitude and latitude and the relative elevation
To determine the existing relative horizontal and vertical positions and to establish marks to control construction or to indicate land boundaries (Correct answer)
To determine the shape of a piece of land and how its elevation changes across the landscape
To determine the landscape of the land and how many acres are in the section being surveyed

Correct answer: To determine the existing relative horizontal and vertical positions and to establish marks to control construction or to indicate land boundaries

Surveying serves two core purposes: determining the existing relative horizontal and vertical positions of points, and establishing marks to control construction or indicate land boundaries. The other options describe only partial or specific tasks (acreage, latitude/longitude, shape and elevation) rather than these two fundamental functions.

Question 6: A facility has a policy stating that all residents must be bathed between 6:00 AM and 8:00 AM, regardless of their personal preferences. A resident who has always been a 'night owl' expresses a strong desire to bathe in the evenings. Which of the following principles is the facility failing to uphold?

The right to make independent choices. (Correct answer)
The right to choose an attending physician.
The right to be free from abuse and neglect.
The right to be informed of their medical condition.

Correct answer: The right to make independent choices.

The Nursing Home Reform Law emphasizes self-determination and accommodating individual needs. Forcing all residents onto a rigid bathing schedule without regard for their lifelong habits and preferences violates their right to make personal decisions and receive reasonable accommodation of their needs, as supported by 42 CFR §483.10.

Question 7: According to 42 CFR §483.24, Quality of Life, the facility must provide an ongoing program of activities designed to meet the interests and support the well-being of each resident. Which of the following is a key requirement for the activities program?

The program must be directed by a local volunteer with community event planning experience.
The facility must offer at least five different activities per day, regardless of resident interest.
Activities must be scheduled only in group settings to encourage socialization.
The program must be based on the comprehensive assessment, care plan, and preferences of each resident. (Correct answer)

Correct answer: The program must be based on the comprehensive assessment, care plan, and preferences of each resident.

Federal regulation 42 CFR §483.24(c) explicitly states that the facility must provide an activities program based on the comprehensive assessment and care plan and the preferences of each resident. This ensures activities are person-centered and meaningful. The other options are incorrect because the program requires a qualified professional, must include individual activities, and is based on resident interest, not an arbitrary number.

Question 8: Which of the following staff behaviors would be classified as 'psychological abuse' of a nursing home resident?

Removing money from a resident's personal funds account without authorization
Failing to reposition a bedridden resident on the schedule documented in the care plan
Repeatedly threatening a resident with punishment if they do not cooperate with personal care (Correct answer)
Administering an incorrect medication dosage that causes the resident discomfort

Correct answer: Repeatedly threatening a resident with punishment if they do not cooperate with personal care

Psychological abuse includes verbal threats, humiliation, intimidation, and other conduct that causes mental anguish or emotional distress to a resident.

Question 9: During a dietary observation, a surveyor finds food stored at 48°F in the walk-in refrigerator. The required maximum safe refrigerator temperature for potentially hazardous foods under federal food safety standards is:

45°F
38°F
50°F
41°F (Correct answer)

Correct answer: 41°F

Federal food safety guidelines and FDA Food Code require potentially hazardous foods to be held at 41°F or below to prevent bacterial growth.

Question 10: A surveyor finds that an LTSS plan restricts enrollees from receiving visitors without staff approval. This most likely violates which Quality of Life requirement?

Provider credentialing standards
Grievance filing timelines
Encounter data accuracy
Freedom from unnecessary restrictions (Correct answer)

Correct answer: Freedom from unnecessary restrictions

Controlling visitor access without justification constitutes an unnecessary restriction on the enrollee's freedom and social connections, violating Quality of Life standards.

Question 11: Which hand hygiene agent is NOT effective against Clostridioides difficile spores?

Soap and water with friction
Alcohol-based hand sanitizer (Correct answer)
Antimicrobial soap
Chlorhexidine gluconate scrub

Correct answer: Alcohol-based hand sanitizer

Alcohol-based hand sanitizers do not kill C. diff spores; soap and water with friction is required to physically remove them.

Question 12: A resident's care plan goal reads: 'Resident will express satisfaction with meal choices by next review.' This goal is problematic because:

Satisfaction goals must be written in the resident's own words
Meal satisfaction is not a valid care plan topic
It lacks a measurable baseline or criterion for success (Correct answer)
Dietary goals require a registered dietitian co-signature

Correct answer: It lacks a measurable baseline or criterion for success

Without a measurable criterion (e.g., 'rates meals ≥7/10 on satisfaction scale'), progress toward this goal cannot be objectively evaluated.

Question 13: Under Quality of Life requirements, an enrollee's right to participate in community activities is best described as which type of right?

An optional service only for high-functioning enrollees
A discretionary benefit subject to plan approval
A privilege granted by the care plan
A fundamental right that plans must actively support (Correct answer)

Correct answer: A fundamental right that plans must actively support

Community integration is a fundamental right for LTSS enrollees, and managed care plans are required to actively support access to community activities.

Question 14: During a kitchen inspection, a surveyor observes several large, unmarked containers of leftover food in the walk-in refrigerator. The kitchen manager states they were from a meal served two days ago. Which of the following food safety requirements is most likely NOT being met?

Procuring food from sources approved by federal, state, or local authorities.
Disposing of garbage and refuse properly.
Storing, preparing, distributing, and serving food in accordance with professional standards for food service safety. (Correct answer)
Providing special eating equipment and utensils for residents who need them.

Correct answer: Storing, preparing, distributing, and serving food in accordance with professional standards for food service safety.

42 CFR §483.60(i)(2) requires facilities to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Proper dating and labeling of leftover food to ensure it is used or discarded within a safe timeframe is a fundamental component of these professional standards. Unmarked, undated containers represent a failure to adhere to these standards.

Question 15: Under 42 CFR §483.30, what is the minimum requirement for physician visits to nursing facility residents following the initial visit?

Every 30 days for the first 90 days, then every 60 days (Correct answer)
Every 30 days indefinitely
At least once per week during acute illness
Every 60 days for the first year, then annually

Correct answer: Every 30 days for the first 90 days, then every 60 days

CMS requires physicians to visit residents at least every 30 days for the first 90 days after admission, then at least every 60 days thereafter.

Question 16: Which federal regulation primarily establishes Quality of Life requirements for Medicaid managed care LTSS enrollees?

45 CFR Part 164
42 CFR Part 483
42 CFR Part 455
42 CFR Part 438 (Correct answer)

Correct answer: 42 CFR Part 438

42 CFR Part 438 governs Medicaid managed care regulations, including Quality of Life standards that plans must meet for LTSS enrollees.

Question 17: When surveying a Medicaid managed care plan's Quality of Life protections, what does 'dignity and respect' primarily require staff to do?

Treat enrollees as capable adults regardless of disability status (Correct answer)
Address enrollees in condescending tones when necessary
Limit enrollee involvement in care conferences
Reduce enrollee contact with the outside community

Correct answer: Treat enrollees as capable adults regardless of disability status

Dignity and respect standards require that staff treat all enrollees as capable adults, honoring their individuality and autonomy regardless of disability or condition.

Question 18: Under OBRA regulations, within how many days of admission must a comprehensive care plan be completed for a long-term care resident?

7 days
14 days
30 days
21 days (Correct answer)

Correct answer: 21 days

OBRA '87 requires a comprehensive care plan to be developed within 21 days of admission to a skilled nursing facility.

Question 19: The closed record review task during a nursing home survey examines records of residents who:

Refused to participate in the open survey sample
Are currently receiving hospice services
Have active grievances pending with the facility
Were discharged or died during a defined look-back period (Correct answer)

Correct answer: Were discharged or died during a defined look-back period

Closed records are those of recently discharged or deceased residents and are reviewed to identify care issues not visible in current residents.

Question 20: The Quality of Life regulation at 42 CFR §483.24(a) states that a facility must provide care and services to ensure a resident's abilities in activities of daily living do not diminish. What is the exception to this requirement?

When the diminution is an unavoidable consequence of the individual's clinical condition. (Correct answer)
When the resident's family provides written consent for the decline.
When the facility has documented a temporary staffing shortage.
When the resident verbally refuses the care or service on three separate occasions.

Correct answer: When the diminution is an unavoidable consequence of the individual's clinical condition.

The regulation at 42 CFR §483.24(a) specifies that the facility's responsibility to prevent decline in ADLs holds "unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable." This acknowledges that some decline is inevitable due to disease progression, but the facility is otherwise responsible for providing care to prevent avoidable decline.

Question 21: A surveyor is reviewing a resident's chart and notes a physician's order for a therapeutic, low-sodium diet. During the lunch observation, the surveyor sees the resident being served a regular, unrestricted meal. This situation most directly points to a potential failure in which regulatory area?

Providing suitable alternative meals upon request.
Ensuring menus are prepared in accordance with physician's orders. (Correct answer)
Procuring food from sources approved by local authorities.
Accommodating resident preferences over physician's orders.

Correct answer: Ensuring menus are prepared in accordance with physician's orders.

According to 42 CFR §483.60(e), therapeutic diets must be prescribed by the attending physician and the facility is responsible for providing food and drink prepared in a form designed to meet individual needs. Serving a regular meal when a specific therapeutic diet has been ordered by the physician is a failure to follow that order.

Question 22: _______________________ surveying works with small-scale regions and makes the assumption that the earth's surface is a plane, meaning that no adjustments for the curvature of the earth are required.

Topographic
G.P.S
Plane (Correct answer)
Geodetic

Correct answer: Plane

Plane surveying treats the earth's surface as flat and is used for small areas where curvature can be ignored. Geodetic accounts for curvature over large areas, while GPS and topographic refer to a positioning technology and feature mapping rather than the flat-plane assumption described.

Question 23: A surveyor observes a staff member entering the room of a resident on contact precautions for MRSA without donning a gown or gloves. This practice is a significant breach of which fundamental infection control principle?

Antibiotic stewardship
Transmission-Based Precautions (Correct answer)
Environmental cleaning protocols
Respiratory hygiene and cough etiquette

Correct answer: Transmission-Based Precautions

Transmission-Based Precautions (which include contact, droplet, and airborne precautions) are used in addition to Standard Precautions for residents with known or suspected infections. For MRSA, Contact Precautions are required, which includes wearing a gown and gloves for all interactions that may involve contact with the patient or their environment.

Question 24: Under 42 CFR §483.10, a resident's right to refuse treatment means the facility must:

Require a physician to override the refusal if the treatment is deemed necessary
Honor the refusal and document it, with staff explaining consequences and exploring alternatives (Correct answer)
Contact the family to make the decision on the resident's behalf
Discharge the resident if they refuse necessary treatment

Correct answer: Honor the refusal and document it, with staff explaining consequences and exploring alternatives

A competent resident's refusal of treatment must be honored, documented, and the facility must explain consequences and offer alternatives.

Question 25: A surveyor is reviewing a resident's record and notes a new order for an antipsychotic medication to manage agitation. Which of the following findings would most strongly suggest that the facility is not in compliance with regulations regarding unnecessary drugs?

The resident's family provided consent for the use of the medication.
The medication was initiated after the resident had a documented altercation with another resident.
The record lacks documentation of non-pharmacological interventions being tried before the medication was started. (Correct answer)
The initial dose prescribed is the lowest recommended dose for geriatric patients.

Correct answer: The record lacks documentation of non-pharmacological interventions being tried before the medication was started.

Federal regulations at 42 CFR §483.45(e) require that residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific, diagnosed condition. Furthermore, guidance emphasizes the use of non-pharmacological approaches first. The absence of documented attempts at non-pharmacological interventions indicates the facility may be using a chemical restraint rather than treating a condition appropriately.

Question 26: When surveying a skilled nursing facility, a surveyor notices a resident's weight has dropped 8% over 30 days. Under MDS coding rules, this weight loss is classified as:

Significant weight loss (Correct answer)
Moderate weight loss
Severe weight loss
Clinically insignificant weight loss

Correct answer: Significant weight loss

A weight loss of 5% or more over 30 days meets the MDS definition of significant weight loss, triggering further assessment.

Question 27: During a SMQT survey, which finding would indicate a plan is NOT meeting Quality of Life privacy requirements?

Personal health information is shared only with treating providers
Enrollees have private rooms available upon request
Care staff discuss enrollee conditions in public hallways (Correct answer)
Enrollees can lock personal belongings

Correct answer: Care staff discuss enrollee conditions in public hallways

Discussing enrollee health conditions in public spaces violates privacy protections that are a fundamental component of Quality of Life requirements.

Question 28: During an inspection of a resident's room in a facility certified after November 28, 2016, a surveyor notes that the room is shared by two residents. Each resident has a bed, a bedside cabinet, and shares a wardrobe. The room has a single window to the outside and an attached bathroom with a toilet and sink. This room configuration is:

Non-compliant, because each resident must have a separate, private room.
Compliant, as it meets the maximum occupancy and furnishing requirements for newer facilities. (Correct answer)
Non-compliant, because regulations require a full private bath with a shower for each room.
Compliant, but only if both residents are related.

Correct answer: Compliant, as it meets the maximum occupancy and furnishing requirements for newer facilities.

For facilities certified after November 28, 2016, 42 CFR §483.90(e) limits resident rooms to a maximum of two residents. It also requires that each resident have a separate bed, bedside cabinet, and access to a wardrobe or closet space, as well as an attached bathroom with at least a toilet and sink.

Question 29: A resident with moderate dementia is observed by a surveyor to be wearing soiled clothing at midday, with staff walking past without intervening. This most directly suggests a deficiency in:

Restraint use policies
Staffing ratios
Infection control practices
Resident dignity and personal hygiene care (Correct answer)

Correct answer: Resident dignity and personal hygiene care

Allowing a resident to remain in soiled clothing indicates a failure to provide care that maintains dignity and basic hygiene, a direct violation of resident rights.

Question 30: A surveyor observes a resident who is unable to perform activities of daily living (ADLs) and appears unkempt, with poorly fitting clothes and uncombed hair. Under the Quality of Life requirements, what is the facility's primary responsibility for this resident?

To contact the family and insist they provide grooming supplies and assistance.
To document the resident's refusal of care and take no further action.
To schedule a weekly shower and grooming session with the resident.
To provide the necessary services to maintain good nutrition, grooming, and personal hygiene. (Correct answer)

Correct answer: To provide the necessary services to maintain good nutrition, grooming, and personal hygiene.

42 CFR §483.24(a)(2) mandates that if a resident is unable to carry out activities of daily living, the facility must provide the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. This is a direct responsibility of the facility to ensure the resident's well-being and dignity. While documenting refusal is important, the facility must still attempt to provide care. Relying solely on family or infrequent scheduling does not meet the regulation.

Question 31: A surveyor reviews a facility's emergency generator testing logs. The logs indicate that the generator is started and tested for 15 minutes every month under the available building load. This practice is:

Non-compliant, as the generator must be tested for a minimum of 30 minutes monthly. (Correct answer)
Non-compliant, as weekly load testing for 30 minutes is required.
Compliant, because monthly testing is the required frequency.
Compliant, as long as a full load test is performed annually.

Correct answer: Non-compliant, as the generator must be tested for a minimum of 30 minutes monthly.

Federal regulations, which incorporate standards from the National Fire Protection Association (NFPA 110), require that emergency generators be exercised under load for at least 30 minutes monthly. A 15-minute test is insufficient to meet this standard for ensuring the generator's reliability during an actual power outage.

Question 32: What should an interviewer note in their case record when the physical environment during an interview was suboptimal?

Mark the interview as invalid and request a replacement respondent
Record only that the interview was completed successfully
Note nothing, as environmental observations are not part of SMQT documentation
Document the specific environmental conditions and any impact on the interview process (Correct answer)

Correct answer: Document the specific environmental conditions and any impact on the interview process

Documenting environmental conditions allows supervisors and researchers to assess potential data quality issues and provides context for any anomalies in responses.

Question 33: A surveyor reviewing a facility's infection control practices notes that dietary staff are not wearing hair restraints while preparing food. This finding MOST directly relates to:

F940 – Staff Training
F880 – Infection Prevention and Control
F812 – Food Procurement/Store/Prepare/Serve-Sanitary (Correct answer)
F803 – Menus and Nutritional Adequacy

Correct answer: F812 – Food Procurement/Store/Prepare/Serve-Sanitary

F812 covers sanitary food preparation practices including personal hygiene measures such as hair restraints for food service staff.

Question 34: When a surveyor conducts a medication administration observation, they are specifically looking for:

Adherence to the 'five rights': right resident, drug, dose, route, and time (Correct answer)
Whether the pharmacy's licensing is current
Whether medications are stored alphabetically in the medication cart
The nurse's years of experience and certification level

Correct answer: Adherence to the 'five rights': right resident, drug, dose, route, and time

The five rights of medication administration are the standard framework for evaluating safe medication practices.

Question 35: Under PASRR, an 'exempted hospital discharge' provision allows admission without a prior Level I screen when:

The facility has an on-site psychiatrist
The resident is discharged directly from a hospital after a short acute-care stay (Correct answer)
The resident is over age 75
The resident has private insurance

Correct answer: The resident is discharged directly from a hospital after a short acute-care stay

Individuals discharged from a hospital after a short-term acute care stay may be admitted under the exempted hospital discharge provision, with PASRR screening completed after admission.

Question 36: A surveyor is reviewing whether a facility properly conducted a PASRR screen. Which individual is exempt from PASRR requirements?

A resident admitted from an acute care hospital for Medicaid-covered skilled care
A resident who previously lived in a psychiatric hospital
A resident admitted for respite care of 30 days or less (Correct answer)
A resident with a dual diagnosis of SMI and intellectual disability

Correct answer: A resident admitted for respite care of 30 days or less

Federal regulations exempt individuals admitted for a short-term stay of 30 days or fewer for respite care from full PASRR requirements.

Question 37: A resident wants to send and receive personal mail without interference. Under CMS regulations, the facility:

Can hold mail until a family member is present to assist
May read outgoing mail to ensure it does not contain complaints
Must permit the resident to send and receive mail unopened (Correct answer)
May open mail to screen for contraband if policy permits

Correct answer: Must permit the resident to send and receive mail unopened

Residents have the right to send and receive personal mail unopened, and facilities cannot interfere with this communication.

Question 38: During a survey, you observe that staff are wearing the same gloves while moving between resident rooms. Which infection control principle is being violated?

Hand hygiene protocol
Glove change between patients to prevent cross-contamination (Correct answer)
Isolation precaution signage
Personal protective equipment storage

Correct answer: Glove change between patients to prevent cross-contamination

Gloves must be changed between patients and hand hygiene performed to prevent transferring pathogens from one resident to another.

Question 39: During a survey, you observe that a nurse administered a medication two hours after the scheduled time without documentation. What is the primary concern?

Failure to follow the prescribed medication schedule and lack of documentation (Correct answer)
The physician was not available to approve the delay
Staff shortage causing delays
The medication was still effective

Correct answer: Failure to follow the prescribed medication schedule and lack of documentation

Surveyors cite facilities when medications are not administered per the physician's order and when deviations are not documented in the medical record.

Question 40: A resident with a court-appointed legal guardian refuses a procedure that the guardian has consented to. How should the facility proceed?

Proceed with the procedure based solely on the guardian's consent
Override the resident's objection since the guardian holds legal authority
Discharge the resident for non-compliance
Attempt to understand the resident's objection, involve the care team, and seek ethics consultation if needed (Correct answer)

Correct answer: Attempt to understand the resident's objection, involve the care team, and seek ethics consultation if needed

Even when a legal guardian holds decision-making authority, the facility should attempt to understand and honor the resident's expressed preferences and involve the care team.

Question 41: During a survey, a surveyor finds documentation indicating a resident was threatened with discharge for reporting complaints about the quality of care. This constitutes:

A legitimate component of the facility's discharge planning process
Retaliation against a resident for exercising their rights, which constitutes a form of prohibited abuse or intimidation (Correct answer)
An appropriate facility policy used to maintain order and manage difficult residents
An isolated verbal disagreement that does not rise to the level of a regulatory citation

Correct answer: Retaliation against a resident for exercising their rights, which constitutes a form of prohibited abuse or intimidation

Threatening discharge in retaliation for reporting complaints violates resident rights and constitutes prohibited intimidation under federal regulations protecting residents' right to voice grievances.

Question 42: A surveyor finds that a hospital's emergency plan was reviewed 30 months ago. Under the 2019 burden-reduction rule, what is the hospital's required review frequency?

Every 3 years
Annually
At least every 2 years (Correct answer)
Every 6 months

Correct answer: At least every 2 years

Since 2019, most providers including hospitals review the plan at least every 2 years, so a 30-month gap is noncompliant.

Question 43: Under the CMS infection control regulations, what is required when a resident is placed on transmission-based precautions?

Notification of the resident's family within 24 hours
Education of the resident about their precaution status and the reason (Correct answer)
Immediate transfer to a hospital
Restriction of all visitation indefinitely

Correct answer: Education of the resident about their precaution status and the reason

Residents have the right to know why precautions are being used, and education must be provided to support their understanding and cooperation.

Question 44: Under 42 CFR §483.12(c), within what timeframe must a nursing facility report an allegation of abuse to the State agency?

48 hours of the alleged occurrence
24 hours of the alleged occurrence (Correct answer)
72 hours of the alleged occurrence
5 working days of the alleged occurrence

Correct answer: 24 hours of the alleged occurrence

Federal regulations require facilities to report allegations of abuse, neglect, or exploitation to the State agency within 24 hours to enable prompt protective action.

Question 45: A resident requests that their care plan goal be changed from 'ambulate 50 feet daily' to 'remain in bed during evening hours.' The facility should:

Require physician approval before making any goal changes
Update the care plan to reflect the resident's preference and document any risks discussed (Correct answer)
Refuse, because the existing goal is clinically superior
Defer the change until the next quarterly review

Correct answer: Update the care plan to reflect the resident's preference and document any risks discussed

Residents have the right to participate in and direct their care; the facility must honor the preference and document informed decision-making.

Question 46: A surveyor observes that the care plan room is locked and staff must request access from the charge nurse to review care plans. The concern with this practice is:

Care plans should be available on the internet for family access
Only the Director of Nursing is permitted to access care plan files
Care plans must be stored in the resident's room by regulation
Restricted access may prevent timely implementation of care plan interventions by all staff (Correct answer)

Correct answer: Restricted access may prevent timely implementation of care plan interventions by all staff

If care plans are not readily accessible to all direct care staff, timely and consistent implementation of interventions is compromised.

Question 47: A resident who is Muslim requests that pork products never be served to them. Under resident rights regulations, the facility must:

Explain that the standard menu cannot be altered for individual requests
Offer only vegetarian meals to all residents to avoid the issue
Transfer the resident to a facility that specializes in religious diets
Provide a pork-free alternative that is nutritionally adequate (Correct answer)

Correct answer: Provide a pork-free alternative that is nutritionally adequate

Facilities must make reasonable accommodations for residents' religious and cultural dietary preferences, providing nutritionally adequate alternatives.

Question 48: During a kitchen observation, a surveyor notices a food service worker handling raw chicken and then preparing a cold salad without washing hands or changing gloves. This practice PRIMARILY violates which food safety principle?

Proper thawing procedures
Cross-contamination prevention (Correct answer)
Temperature control
Pest control standards

Correct answer: Cross-contamination prevention

Moving from raw poultry to ready-to-eat foods without hand hygiene or glove change is a direct cross-contamination risk, a critical food safety violation.

Question 49: A surveyor is reviewing the discharge planning component of a resident's comprehensive care plan. The plan should include documentation of which of the following?

The personal financial statements of the family members who will be assisting the resident.
A guarantee of the resident's successful transition back to the community.
A signed contract with a home health agency for post-discharge services.
An assessment of the resident's preference and potential for future discharge. (Correct answer)

Correct answer: An assessment of the resident's preference and potential for future discharge.

The regulations require that the comprehensive care plan, in consultation with the resident and their representative, documents the resident's preference and potential for future discharge. This includes assessing their desire to return to the community and making appropriate referrals if indicated.

Question 50: According to federal regulations for skilled nursing facilities (42 CFR §483.35), which of the following is a mandatory daily staffing requirement for a Registered Nurse (RN), unless a waiver is granted?

An RN must hold the position of facility administrator.
An RN must be on-site 24 hours a day, 7 days a week.
The facility must employ at least one RN for every 30 residents.
An RN must be on duty for at least 8 consecutive hours, 7 days a week. (Correct answer)

Correct answer: An RN must be on duty for at least 8 consecutive hours, 7 days a week.

Federal regulation 42 CFR §483.35(b)(1) explicitly requires a facility, except when waived, to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. While a licensed nurse must be on duty 24/7, the specific requirement for an RN is the 8-hour daily minimum.

Question 51: Creating a ______________ to depict the relative locations of the things on Earth's surface is the goal of surveying.

land surveying
topographic survey
plan or map (Correct answer)
location survey

Correct answer: plan or map

The fundamental goal of surveying is to produce a plan or map that depicts the relative locations of features on the Earth's surface. The other options name specific survey types or activities, not the graphical end product that surveying is meant to create.

Question 52: If a surveyor finds that care plan goals are not being met and interventions are not being followed by staff, the root cause investigation should first examine:

Whether the care plan was laminated properly
Whether the administrator signed off on the care plan
Whether staff were educated on the care plan and whether the plan is accessible at point of care (Correct answer)
Whether the resident agreed with the goals in writing

Correct answer: Whether staff were educated on the care plan and whether the plan is accessible at point of care

Implementation failures often stem from staff not knowing about or having access to the care plan, making education and accessibility the first root cause to examine.

Question 53: A facility's policy requires all residents to attend morning exercises. A resident refuses to attend, citing their right to choose their activities. The facility:

Must honor the resident's right to choose their schedule and activities (Correct answer)
May require attendance since group activities support clinical goals
Should place the resident in a supervision room during the exercise period
Can document the refusal and bill the family for the missed session

Correct answer: Must honor the resident's right to choose their schedule and activities

Residents have the right to choose their activities and daily schedule, and mandatory participation in activities violates this right.

Question 54: A care plan correctly identifies a pressure injury but the interventions listed have not been updated despite documented wound progression. A surveyor would cite this as:

Acceptable because the problem was identified
Not a deficiency unless the wound reaches Stage 3
A deficiency because the care plan must be revised when conditions change (Correct answer)
Acceptable if the physician has not ordered new treatment

Correct answer: A deficiency because the care plan must be revised when conditions change

Care plans must be updated to reflect current status; failing to revise interventions when a wound progresses constitutes a care planning deficiency.

Question 55: A facility's pharmacist recommends discontinuing a medication, but the attending physician disagrees and documents a clinical rationale for continuing. How should the surveyor view this?

Automatic deficiency because the pharmacist's recommendation was not followed
Compliant, provided the physician's reasoning is clinically documented and the resident is monitored (Correct answer)
Non-compliant unless a second physician agrees
A citation for the pharmacist for overstepping their role

Correct answer: Compliant, provided the physician's reasoning is clinically documented and the resident is monitored

Physicians may override pharmacist recommendations when they document a valid clinical rationale; the key survey criterion is that the recommendation was received, considered, and a documented response was made.

Question 56: Under Medicaid managed care Quality of Life standards, which principle ensures that enrollees retain the right to make personal decisions about their daily lives?

Self-determination (Correct answer)
Utilization management
Clinical oversight
Care coordination

Correct answer: Self-determination

Self-determination is a core Quality of Life principle that allows enrollees to make their own choices about daily activities, routines, and life decisions.

Question 57: A resident's MDS indicates a BIMS score of 6. How should the surveyor interpret this finding?

Score is invalid and should be re-administered
Moderately impaired cognition
Severely impaired cognition (Correct answer)
Intact cognition — no further assessment needed

Correct answer: Severely impaired cognition

BIMS scores of 0–7 indicate severely impaired cognition, meaning the resident has significant difficulty with memory and daily decision-making.

Question 58: A surveyor is evaluating the physical environment of a nursing facility. Which of the following findings would represent a direct violation of the standards for a resident's room as outlined in 42 CFR §483.90?

The presence of a landline telephone jack, although no phone is currently connected.
A resident using their own personal, electrically-safe television that they brought from home.
The facility's maintenance staff changing a ceiling light bulb during the afternoon.
A semi-private room where the privacy curtain between the beds does not extend fully around one of the beds. (Correct answer)

Correct answer: A semi-private room where the privacy curtain between the beds does not extend fully around one of the beds.

42 CFR §483.90(e)(1)(v) requires the facility to provide "full visual privacy for each resident." A privacy curtain that does not fully enclose the bed space fails to meet this requirement for the resident in a semi-private room.

Question 59: A surveyor reviews a facility's antibiotic stewardship program. Which element is MOST critical to evaluate first?

Whether a physician reviews and documents clinical indication for each antibiotic order (Correct answer)
Cost of antibiotics purchased in the last quarter
Number of antibiotic courses dispensed per month
Brand versus generic antibiotic usage rates

Correct answer: Whether a physician reviews and documents clinical indication for each antibiotic order

Antibiotic stewardship requires documented clinical justification for each order to ensure antibiotics are prescribed only when appropriate.

Question 60: During a survey, a team gathers information to determine a facility's compliance. Which of the following is NOT one of the three core information-gathering tasks surveyors use?

Review of clinical records and other documents.
Interviews with residents and staff.
Implementation of corrective actions. (Correct answer)
Observation of care and procedures.

Correct answer: Implementation of corrective actions.

The fundamental tasks of the survey process are observation, interview, and record review. Surveyors use these methods to collect evidence. Implementing corrective actions is the responsibility of the facility after deficiencies have been formally cited, not a task for the surveyor during the information-gathering phase.

Question 61: When assessing pain in a resident who cannot self-report, the MDS directs staff to use:

Staff observation of pain-related behaviors (Correct answer)
Physician documentation exclusively
Pharmacy medication records
Family report only

Correct answer: Staff observation of pain-related behaviors

For non-verbal residents, the MDS directs assessment of observable pain-related behaviors such as facial grimacing, crying, or guarding.

Question 62: A certified dietary manager (CDM) is overseeing dietary operations in a SNF without a consultant dietitian on site. Under CMS regulations, which staffing arrangement is minimally acceptable?

A food service manager with 5 years experience may replace a dietitian
A CDM alone can fulfill all dietitian functions permanently
A CDM may manage day-to-day operations if a qualified dietitian consults on a regularly scheduled basis (Correct answer)
Any licensed nurse can substitute for a dietitian in dietary oversight

Correct answer: A CDM may manage day-to-day operations if a qualified dietitian consults on a regularly scheduled basis

CMS allows a CDM to manage daily dietary services provided that a qualified dietitian provides regularly scheduled consultation to ensure clinical nutrition needs are met.

Question 63: A resident who practices Islam informs the dietary manager that they cannot eat the pork-based main entree served at dinner. The facility's policy is to offer a peanut butter sandwich as the only alternative meal. This practice may be deficient because the facility is failing to:

Ensure the Director of Food and Nutrition Services is properly certified.
Offer appealing options of similar nutritive value. (Correct answer)
Provide a therapeutic diet as ordered by the physician.
Serve meals at times comparable to the community.

Correct answer: Offer appealing options of similar nutritive value.

Federal regulations at 42 CFR §483.60(d)(5) require that the facility provide appealing options of similar nutritive value to residents who choose not to eat the food that is initially served. While a peanut butter sandwich provides some nutrition, it may not be of similar nutritive value to the main entree and may not be considered an appealing or sufficient alternative, especially if it is the only option offered consistently. The regulations also emphasize accommodating cultural and religious needs.

Question 64: A surveyor reviews a facility where enteral tube feeding is used for a cognitively intact resident who had not consented to this intervention. This scenario MOST directly raises concerns under:

F812 – Food Sanitation
F578 – Request/Refuse Treatment; Formulate Advance Directives (Correct answer)
F804 – Nutritive Value of Foods
F636 – Comprehensive Assessment

Correct answer: F578 – Request/Refuse Treatment; Formulate Advance Directives

A cognitively intact resident has the right to refuse any treatment including tube feeding; proceeding without consent violates F578 (right to refuse treatment).

Question 65: A facility uses a computerized care plan system that auto-populates generic interventions from the MDS. A surveyor's concern with this practice would be:

Auto-populated plans may not be individualized to the specific resident (Correct answer)
Only paper care plans are legally enforceable
Generic interventions are acceptable as long as they are reviewed annually
Electronic care plans are not accepted by CMS

Correct answer: Auto-populated plans may not be individualized to the specific resident

Even when using electronic systems, care plans must be individualized; generic auto-populated content that is not customized constitutes a deficiency.

Question 66: Which interdisciplinary team member is primarily responsible for coordinating the comprehensive care plan meeting?

The Director of Nursing
The Social Worker
The attending physician
The Registered Nurse or designated care coordinator (Correct answer)

Correct answer: The Registered Nurse or designated care coordinator

A registered nurse or designated care coordinator typically organizes and leads the interdisciplinary care plan conference.

Question 67: Per CMS requirements, the individual designated as the facility's Infection Preventionist (IP) must meet several qualifications, including:

Working at least part-time at the facility. (Correct answer)
Having at least 10 years of experience as a Director of Nursing.
Being a board-certified infectious disease physician.
Holding a master's degree in public health.

Correct answer: Working at least part-time at the facility.

CMS regulations require that the designated Infection Preventionist (IP) must work at least part-time at the facility and have primary professional training in a relevant field (like nursing, epidemiology, etc.), and have completed specialized training in infection prevention and control. While extensive experience or specific advanced degrees are valuable, the 'part-time, on-site' requirement is a specific regulatory mandate.

Question 68: The Brief Interview for Mental Status (BIMS) is scored on a scale of 0 to:

20
12
10
15 (Correct answer)

Correct answer: 15

The BIMS is scored from 0 to 15, with scores of 13–15 indicating intact cognition.

Question 69: Which of the following services, if required to meet a resident's needs, must be described in the comprehensive care plan?

Services that are culturally-competent and trauma-informed. (Correct answer)
A list of preferred television channels for the resident's room.
Experimental treatments not yet approved by the FDA.
Only services provided directly by facility employees.

Correct answer: Services that are culturally-competent and trauma-informed.

The regulations at §483.21(b)(3) and associated surveyor guidance emphasize that services outlined in the comprehensive care plan must be culturally-competent and trauma-informed. This ensures that care is respectful of and responsive to individual resident's preferences, needs, and values.

Question 70: The daughter of a competent resident, who holds no legal authority like a power of attorney, insists that the facility staff not inform her mother about a new, potentially life-sustaining medication prescribed by the physician. What is the facility's proper course of action in respecting resident rights?

Follow the daughter's instructions to avoid family conflict.
Ask the daughter to sign a form taking responsibility for the decision.
Inform the resident fully about the new medication and her right to refuse it. (Correct answer)
Administer the medication without discussion since it was prescribed by the physician.

Correct answer: Inform the resident fully about the new medication and her right to refuse it.

A competent resident has the absolute right to be fully informed about their medical condition and treatment options, and to participate in their own care, which includes the right to refuse treatment. The daughter's wishes do not override the resident's right to self-determination unless she is the legally appointed representative for a resident deemed incompetent.

Question 71: A surveyor observes that a resident's MDS assessment is inconsistent with direct observations and staff interviews, indicating the resident is more capable than assessed. This discrepancy in the assessment process most directly compromises the facility's ability to:

Ensure proper financial guardianship.
Develop an accurate, person-centered care plan. (Correct answer)
Notify the resident's physician of a change in condition.
Comply with PASRR Level I screening timelines.

Correct answer: Develop an accurate, person-centered care plan.

The accuracy of the MDS assessment is foundational to the entire care planning process. If the assessment does not accurately reflect the resident's status and abilities, the resulting care plan cannot be truly individualized or effective in meeting the resident's needs and promoting their highest practicable well-being.

Question 72: During a survey, you review the activities calendar and notice that all scheduled events are large-group activities like bingo and movie nights. A resident tells you she misses painting, which she used to do alone in her room. This situation might indicate non-compliance with which aspect of the Quality of Life regulation?

The requirement to provide daily outdoor access for all residents.
The requirement to maintain a full-time, state-approved Activities Director.
The requirement to support residents in their choice of both group and individual activities. (Correct answer)
The requirement for specialized rehabilitative services.

Correct answer: The requirement to support residents in their choice of both group and individual activities.

According to 42 CFR §483.24(c)(1), the facility's activities program must support residents in their choice of activities, which includes both facility-sponsored group and individual activities, as well as independent activities. Failing to provide opportunities or support for individual pursuits like painting could be a deficiency in this area.

Question 73: Under OBRA regulations, which of the following best describes a resident's right to receive visitors?

Visiting hours are entirely within the facility's discretion
Visitors must be approved by the attending physician before entry
Residents have the right to receive visitors of their choice at any time, subject to reasonable clinical restrictions (Correct answer)
Visitors may be limited to immediate family members only

Correct answer: Residents have the right to receive visitors of their choice at any time, subject to reasonable clinical restrictions

Residents have the right to receive visitors of their choosing, and facilities may only impose reasonable, clinically justified restrictions.

Question 74: A surveyor is reviewing the facility's response to an influenza outbreak. Which of the following interventions demonstrates correct implementation of Droplet Precautions?

Disinfecting all surfaces with an EPA-registered sporicidal agent.
Cohorting ill residents and having them wear a facemask when outside their room. (Correct answer)
Requiring staff to wear N95 respirators for all resident contact.
Placing all residents on a prophylactic course of antibiotics.

Correct answer: Cohorting ill residents and having them wear a facemask when outside their room.

Droplet Precautions are used for infections spread by respiratory droplets, like influenza. Key interventions include placing patients in a private room or cohorting them (placing them in a room with other infected residents), and having the patient wear a mask when they must be transported outside the room to contain respiratory secretions.

Question 75: Under OBRA regulations, the role of the dietitian in a SNF includes all of the following EXCEPT:

Performing nutrition-focused physical assessments
Prescribing medications to treat malnutrition (Correct answer)
Counseling residents and families on nutritional needs
Developing individualized nutrition care plans

Correct answer: Prescribing medications to treat malnutrition

Dietitians are not licensed to prescribe medications; their scope includes assessment, care planning, education, and nutritional intervention, not pharmacological prescription.

Question 76: The MDS Discharge assessment must be completed within how many days after the resident leaves the facility?

7 days (Correct answer)
3 days
1 day
14 days

Correct answer: 7 days

The Discharge assessment (return not anticipated) must be completed within 7 days after the resident's discharge from the facility.

Question 77: Which action by a surveyor best evaluates whether a facility is honoring residents' right to choose their daily schedule?

Review the facility's posted activity calendar
Interview residents about whether they can choose when to wake up, eat, and sleep (Correct answer)
Confirm the facility has a written resident rights policy
Check if the social worker documents schedule preferences in the care plan

Correct answer: Interview residents about whether they can choose when to wake up, eat, and sleep

Directly interviewing residents about their daily schedule choices is the most reliable way to assess whether the right is being honored in practice.

Question 78: A state's PASRR program must include which two categories of individuals for evaluation?

Depression and substance use disorder
Serious mental illness (SMI) and intellectual disability (ID) (Correct answer)
Autism and physical disability
Dementia and traumatic brain injury

Correct answer: Serious mental illness (SMI) and intellectual disability (ID)

Federal PASRR law specifically targets individuals with serious mental illness and intellectual disability as the two populations requiring screening and evaluation.

Question 79: A surveyor reviews a resident's care plan and notes that hydration goals are not documented despite the MDS indicating the resident is at risk for dehydration. The MOST relevant F-tag is:

F675 – Quality of Life
F692 – Nutritional Status
F656 – Comprehensive Care Plans (Correct answer)
F636 – Comprehensive Assessments

Correct answer: F656 – Comprehensive Care Plans

F656 requires that care plans address identified needs including hydration, so an absent hydration goal for a resident at risk violates the comprehensive care plan requirement.

Question 80: During PASRR review, a surveyor should verify that the state's PASRR determination was:

Filed in the corporate office records
Included in the resident's clinical record and used in care planning (Correct answer)
Completed exclusively by the facility's social worker
Sent only to the state Medicaid agency

Correct answer: Included in the resident's clinical record and used in care planning

PASRR determinations must be in the resident's clinical record and must inform the individualized plan of care.

Question 81: Determining the dimensions and form of the earth is the focus of __________________ surveying. Large areas, such as a state or county, would be surveyed using this type.

Geodetic (Correct answer)
G.P.S.
Topographic
Plane

Correct answer: Geodetic

Geodetic surveying focuses on determining the size and shape of the earth and is used for very large areas like states or counties, where curvature matters. Plane surveying ignores curvature and suits only small areas, while topographic and GPS describe what is mapped or the tool used, not the large-scale, curvature-accounting purpose.

Question 82: Surveyors use this for fixed points of reference that are known to be elevated above or below a specific datum.

A reference tag
A survey mark
A P.O.R
A benchmark (Correct answer)

Correct answer: A benchmark

A benchmark is the standard surveying term for a permanent fixed point of known elevation relative to a datum, used as a reference. 'Survey mark' and 'reference tag' are vaguer markers not tied specifically to a known elevation, and 'P.O.R' is not the established term for an elevation reference point.

Question 83: Which location would be LEAST suitable for conducting a sensitive income and benefits survey?

A private office with the door closed
The respondent's kitchen with only the respondent and interviewer present
A busy waiting room at a community center with other people seated nearby (Correct answer)
A quiet bedroom in the respondent's home

Correct answer: A busy waiting room at a community center with other people seated nearby

Public or semi-public spaces with uninvolved bystanders violate privacy standards, making respondents less likely to accurately report sensitive financial information.

Question 84: Regarding QAA committee records, surveyors generally:

May use the committee's good-faith findings as the basis for sanctions
May require the facility to hand over all QAA minutes
Must cite the facility if it refuses to share root-cause analyses
May not require disclosure of QAA records except to determine compliance with the QAA requirements themselves (Correct answer)

Correct answer: May not require disclosure of QAA records except to determine compliance with the QAA requirements themselves

Under 483.75(h)-(i), the State or Secretary may not require disclosure of QAA records except to determine compliance with the QAA requirements. Good-faith attempts by the committee to identify and correct quality deficiencies may not be used as a basis for sanctions.

Question 85: A facility's policy states care plans are updated 'as needed.' A surveyor would find this policy deficient primarily because:

Regulations mandate minimum review frequencies that cannot be replaced by discretionary language (Correct answer)
Policies are irrelevant if the care plans themselves are current
Policies must state specific staff responsible for updates
The phrase 'as needed' is not an approved CMS term

Correct answer: Regulations mandate minimum review frequencies that cannot be replaced by discretionary language

Federal rules require quarterly review at minimum; a policy permitting updates only 'as needed' creates a gap where mandatory reviews could be skipped.

Question 86: During a survey, a resident reports feeling sedated all day after a new medication was started last week. There is no reassessment note in the chart. What regulatory requirement is most relevant?

The medication cannot be given until a new physician order is written
The family must be informed before any assessment is done
The pharmacy must be contacted immediately to change the medication
The facility must conduct a comprehensive resident assessment and monitor for adverse drug reactions, documenting findings (Correct answer)

Correct answer: The facility must conduct a comprehensive resident assessment and monitor for adverse drug reactions, documenting findings

Facilities are required to monitor residents for adverse medication effects and document clinical reassessments, particularly when new symptoms emerge after a medication change.

Question 87: A resident's care plan was developed and signed 90 days ago but has not been reviewed since. The resident recently developed a urinary tract infection that resolved two weeks ago. Is a care plan revision required?

No, because quarterly reviews are optional for short-term clinical events
Yes if the infection caused a significant change; otherwise the quarterly review is sufficient (Correct answer)
Yes, because any new clinical event requires a care plan update regardless of resolution
No, because the infection resolved and no ongoing problem exists

Correct answer: Yes if the infection caused a significant change; otherwise the quarterly review is sufficient

A resolved, uncomplicated UTI is unlikely to constitute a significant change requiring an unscheduled revision, but it should be addressed at the next quarterly review.

Question 88: A PASRR Level I screen must be completed before an individual is admitted to a NF on a:

Voluntary basis only
Medicaid-certified basis (Correct answer)
Skilled nursing basis only
Private-pay basis only

Correct answer: Medicaid-certified basis

PASRR Level I screening is required prior to admission to any Medicaid-certified nursing facility.

Question 89: Which of the following is NOT a permissible basis for a facility-initiated discharge under federal LTC requirements?

The resident has failed to pay after reasonable and appropriate notice
The resident's health has improved so they no longer need the facility's services
The facility ceases to operate
The resident's family frequently files grievances about care (Correct answer)

Correct answer: The resident's family frequently files grievances about care

The regulation lists six allowable reasons: needs cannot be met, health has improved, the safety of others is endangered, the health of others is endangered, nonpayment after notice, and facility closure. Discharging a resident because the family files grievances is retaliation and is prohibited.

Question 90: A surveyor finds that a facility administers medications from multi-dose vials to multiple residents and reuses needles between draws from the same vial. What is the primary concern?

Improper medication storage temperature
Increased medication waste
Violation of controlled substance regulations
Risk of cross-contamination and transmission of bloodborne pathogens (Correct answer)

Correct answer: Risk of cross-contamination and transmission of bloodborne pathogens

Reusing needles with multi-dose vials can introduce contaminants into the vial and transmit bloodborne pathogens between patients, a serious infection control and pharmaceutical services deficiency.

Question 91: Which scenario best demonstrates a systemic care planning deficiency versus an isolated individual deficiency?

One care plan goal was not updated after a minor medication change
One resident's care plan is missing a dietary goal
Multiple residents' care plans lack psychosocial goals despite documented depression diagnoses (Correct answer)
A single care plan conference was held without the social worker present

Correct answer: Multiple residents' care plans lack psychosocial goals despite documented depression diagnoses

A pattern of missing psychosocial goals across multiple residents with identified depression indicates a systemic failure rather than an isolated error.

Question 92: During a survey, a resident tells the surveyor they are afraid to complain about care because they fear retaliation from staff. This concern relates most directly to the resident's right to:

Access their medical records
Refuse treatment
Receive visitors of their choice
Voice grievances without discrimination or reprisal (Correct answer)

Correct answer: Voice grievances without discrimination or reprisal

Residents have the explicit right to voice grievances without fear of discrimination, interference, coercion, or reprisal from the facility or its staff.

Question 93: Under CMS regulations, how long does a facility have to resolve a resident's grievance after it is submitted?

24 hours
3 days
Within a reasonable time frame, not to exceed 15 calendar days (Correct answer)
30 days

Correct answer: Within a reasonable time frame, not to exceed 15 calendar days

Facilities must resolve grievances within a reasonable time frame not exceeding 15 calendar days, unless the resident agrees to an extension.

Question 94: A resident experiences a major decline in their cognitive and functional abilities after a stroke. The facility determines this is a 'significant change in status.' According to federal regulations, within how many days must the facility complete a comprehensive resident assessment?

At the next scheduled quarterly review.
Within 14 days of determining the change is significant. (Correct answer)
Within 7 days of the stroke.
Within 48 hours of the physician's order.

Correct answer: Within 14 days of determining the change is significant.

According to 42 CFR §483.20, a comprehensive assessment must be completed within 14 calendar days after the facility determines that a significant change in the resident's physical or mental condition has occurred. This timeline is distinct from quarterly reviews and is triggered by the determination of the change, not necessarily the event itself.

Question 95: When documenting an observation of a potential deficiency, surveyors should record:

Staff disciplinary history for the persons involved
The resident's full name and Social Security number
Only the conclusion that a regulation was violated
Specific details including time, location, what was seen, and who was present (Correct answer)

Correct answer: Specific details including time, location, what was seen, and who was present

Detailed, objective documentation including time, place, and observable facts is required to support any potential citation.

Question 96: Which of the following practices BEST demonstrates appropriate respiratory hygiene and cough etiquette in a long-term care setting?

Prohibiting staff from working if they have any cough
Isolating all coughing residents immediately
Requiring all visitors to wear N95 respirators
Providing tissues, waste receptacles, and hand sanitizer at the entrance (Correct answer)

Correct answer: Providing tissues, waste receptacles, and hand sanitizer at the entrance

Providing tissues, no-touch waste disposal, and hand hygiene supplies at points of entry is the recommended approach for respiratory hygiene.

Question 97: A nursing facility uses a single shared medication cart key kept at the nurses' station accessible to all staff. What survey deficiency does this most likely represent?

Dietary services deficiency
Staffing ratio violation
Inadequate controlled substance security, as medications must be accessible only to authorized personnel (Correct answer)
Fire safety violation

Correct answer: Inadequate controlled substance security, as medications must be accessible only to authorized personnel

Federal regulations require that medications, especially controlled substances, be stored securely with access limited to authorized licensed personnel.

Question 98: A surveyor discovers that a facility failed to investigate an allegation of sexual abuse involving two residents. The most appropriate regulatory finding is:

No citation is warranted because the incident involved two residents rather than a staff-perpetrated act
Referral to law enforcement with no facility citation because criminal matters supersede regulatory action
Citation under F600 for failure to protect residents from abuse and for failure to conduct a required investigation (Correct answer)
Citation only if the investigation would have substantiated that sexual abuse actually occurred

Correct answer: Citation under F600 for failure to protect residents from abuse and for failure to conduct a required investigation

Facilities must investigate all allegations of abuse including resident-to-resident incidents, and failure to investigate is independently citable under F600 regardless of the likely outcome.

Question 99: A resident with dementia is assessed as having high fall risk but refuses to use a bed alarm or call light. The care plan should:

Document refusal, offer alternatives, and include all feasible interventions the resident will accept (Correct answer)
Document refusal and exclude fall interventions since the resident refused
Contact state authorities before proceeding
Override the refusal because the resident lacks decision-making capacity

Correct answer: Document refusal, offer alternatives, and include all feasible interventions the resident will accept

Even when a resident refuses specific interventions, the facility must document the refusal, provide education, and implement all other feasible safety measures.

Question 100: How often must a long-term care facility review and update its emergency preparedness program?

Every 5 years
At least every 2 years
At least annually (Correct answer)
Only after an actual emergency

Correct answer: At least annually

The 2019 burden-reduction rule moved many provider types to biennial reviews, but LTC facilities must still review and update their emergency preparedness program at least annually.

Question 101: What kind of surveying tool is that in the photo?

Stationary receiver
Rotating laser detector (Correct answer)
Level Indicator
Battery pack

Correct answer: Rotating laser detector

A rotating laser detector (receiver) is the accessory that locates the spinning laser beam to find precise level or grade. A 'level indicator', 'stationary receiver', and 'battery pack' are not the term for the device that detects the rotating laser's plane.

Question 102: Which term describes a deficiency that causes no actual harm but has the potential for more than minimal harm?

Immediate jeopardy
Isolated deficiency
Actual harm
No actual harm with potential for more than minimal harm (Correct answer)

Correct answer: No actual harm with potential for more than minimal harm

Deficiencies are classified as 'no actual harm with potential for more than minimal harm' when residents are not yet hurt but could be.

Question 103: When surveying medication reconciliation practices at a hospital, which patient transition is most associated with high-risk medication errors?

Discharge from the hospital to home
Transfer between rooms on the same unit
Transfer from ICU to a step-down unit
Admission from home to the hospital (Correct answer)

Correct answer: Admission from home to the hospital

Admission from home is a high-risk transition because complete and accurate home medication lists are often unavailable, leading to omissions or duplications.

Question 104: A resident's family member requests that the facility not share the resident's diagnosis with the resident. Under HIPAA and CMS regulations, the facility should:

Disclose the diagnosis only to the attending physician
Provide the resident access to their own medical records regardless of family preference (Correct answer)
Honor the family's request to protect the resident from distress
Require the family to obtain a court order before restricting information

Correct answer: Provide the resident access to their own medical records regardless of family preference

Residents have the right to access their own medical records and to be fully informed of their health status; family preferences cannot override this right.

Question 105: During a survey, you observe a nurse aide loudly discussing a resident's recent incontinence episode with another aide in the hallway, within earshot of other residents and visitors. This action infringes upon the resident's right to:

Be free from discrimination.
Participate in activities.
Be treated with dignity and respect. (Correct answer)
Manage their own financial affairs.

Correct answer: Be treated with dignity and respect.

Discussing a resident's sensitive medical information in a public area where it can be overheard fails to treat the resident with consideration and respect for their dignity. The right to dignity and privacy in personal care is a fundamental resident right under 42 CFR §483.10(h)(1).

Question 106: Under the compliance and ethics program requirement (42 CFR 483.85), operating organizations with how many or more facilities must have additional elements such as a designated compliance officer?

2
5 (Correct answer)
25
10

Correct answer: 5

Organizations operating five or more facilities must meet additional requirements. These include mandatory annual training, a designated compliance officer reporting to the governing body, and compliance liaisons at each facility.

Question 107: A facility fails to transmit MDS data to the CMS national repository within the required timeframe. Which consequence can a surveyor cite?

A deficiency citation under F-tag regulations governing assessments and care planning (Correct answer)
Mandatory reduction in certified beds
Immediate termination from Medicaid only
Automatic license suspension

Correct answer: A deficiency citation under F-tag regulations governing assessments and care planning

Failure to submit MDS data within required timeframes is citable as a deficiency under the F-tag regulatory framework.

Question 108: During a survey, a team member notes that a new resident, admitted 72 hours ago, has a baseline care plan in their record. However, a comprehensive care plan has not yet been developed. How should the surveyor proceed?

Determine if the baseline care plan contains the minimum necessary information for the resident's immediate care. (Correct answer)
Assume the facility is developing the comprehensive plan and move on.
Cite the facility for non-compliance, as the comprehensive plan must be done within 48 hours.
Immediately interview the resident's family to understand the delay.

Correct answer: Determine if the baseline care plan contains the minimum necessary information for the resident's immediate care.

Federal regulations at 42 CFR §483.21(a) require a baseline care plan to be developed within 48 hours of admission. This plan should include essential information like initial goals, physician orders, and dietary needs to ensure proper care until the comprehensive plan is completed. The surveyor's first step is to assess the adequacy of this baseline plan.

Question 109: A facility proposes to transfer a resident to another room within the facility. What does the resident rights regulation require?

Room transfers require written consent from the resident's legal representative only
The facility may transfer the resident immediately if a clinical rationale exists
The facility must give advance notice and explain the reason for the transfer (Correct answer)
Room transfers within the facility require no advance notice

Correct answer: The facility must give advance notice and explain the reason for the transfer

Residents must receive advance notice of room transfers and an explanation of the reason, as room changes affect the resident's home environment.

Question 110: Which section of the MDS captures a resident's cognitive skills for daily decision-making?

Section B
Section E
Section C (Correct answer)
Section D

Correct answer: Section C

Section C (Cognitive Patterns) of the MDS assesses cognitive skills including the Brief Interview for Mental Status (BIMS).

Question 111: A surveyor discovers that a facility failed to investigate and report an allegation of resident-to-resident abuse. The MOST appropriate action is to:

Cite deficiencies under abuse prohibition and reporting requirements (Correct answer)
Issue a courtesy warning and allow 30 days for self-correction
Document the finding but defer citation pending the facility's own investigation
Refer the matter solely to local law enforcement and take no survey action

Correct answer: Cite deficiencies under abuse prohibition and reporting requirements

Failure to investigate and report abuse allegations constitutes a citable deficiency independent of local law enforcement action.

Question 112: Under federal regulations, what must a facility do regarding an employee for whom abuse has been substantiated?

Allow continued employment contingent upon successful completion of mandatory retraining
Reassign the employee exclusively to administrative or non-resident-contact positions
Prohibit future employment and report to the appropriate nurse aide registry or applicable licensing authority (Correct answer)
Place the employee on permanent probation within the facility with enhanced supervision

Correct answer: Prohibit future employment and report to the appropriate nurse aide registry or applicable licensing authority

Facilities must terminate employees with substantiated abuse findings and report them to the State nurse aide registry or licensing authority to prevent employment in other care settings.

Question 113: A nursing facility serving Medicaid residents fails to conduct PASRR Level I screens on new admissions. Under OBRA 1987, which agency has enforcement authority over this violation?

The state survey agency acting on behalf of CMS (Correct answer)
The resident's managed care organization
The local health department
The Joint Commission

Correct answer: The state survey agency acting on behalf of CMS

State survey agencies, acting under CMS authority, have enforcement responsibility for PASRR compliance in Medicaid-certified nursing facilities.

Question 114: Regarding a resident's right to share a room with a spouse, CMS regulations state that:

Room sharing between spouses requires a physician's order
Spousal room sharing is only permitted in assisted living settings, not nursing facilities
Room assignments are solely based on clinical need and the facility's discretion
Spouses who are both residents of the same facility have the right to share a room if they choose (Correct answer)

Correct answer: Spouses who are both residents of the same facility have the right to share a room if they choose

Residents who are married and both reside in the same nursing facility have the regulatory right to share a room if they both consent.

Question 115: A surveyor notes a pattern of missed call-light responses across multiple residents. The scope assigned would most likely be:

Isolated
Immediate jeopardy
Pattern (Correct answer)
Widespread

Correct answer: Pattern

A 'pattern' scope is used when a deficiency affects more than a limited number of residents but is not ubiquitous throughout the facility.

Question 116: During a survey, a surveyor finds a resident's care plan does not address a newly identified pressure injury documented in the MDS. This is an example of a failure in:

Comprehensive discharge planning
Minimum Data Set transmission
PASRR Level II follow-up
Care plan development based on assessment findings (Correct answer)

Correct answer: Care plan development based on assessment findings

Federal requirements mandate that care plans be developed from comprehensive assessment data, including MDS findings such as pressure injuries.

Question 117: A surveyor observes a single instance of a nurse aide failing to perform hand hygiene when entering a resident's room. The aide has no other performance issues, and no resident was harmed. When making a compliance decision, this single observation is most likely to be considered what type of deficient practice?

A system failure in the facility's infection control program.
An isolated incident with potential for minimal harm. (Correct answer)
A pattern of poor practice requiring a directed plan of correction.
A widespread issue that constitutes immediate jeopardy.

Correct answer: An isolated incident with potential for minimal harm.

This scenario describes a single, contained event. An 'isolated' scope means the issue is limited to one or a very small number of residents or staff. Since no harm occurred, but there was a lapse in infection control, it represents a 'potential for minimal harm'. The other options describe more serious and widespread issues not supported by this single observation.

Question 118: A surveyor is reviewing a facility's advance directive policies. Which finding would indicate a deficiency in honoring resident rights?

The facility refuses to honor a resident's DNR order because it conflicts with staff values (Correct answer)
The facility provides information about advance directives to all residents
The facility documents the resident's advance directive status in the medical record
The facility asks about advance directives at admission

Correct answer: The facility refuses to honor a resident's DNR order because it conflicts with staff values

Facilities must honor valid advance directives including DNR orders; staff personal beliefs cannot override a resident's legally executed directive.

Question 119: While observing a housekeeping staff member cleaning a resident corridor, a surveyor notices that the floor buffing machine has a frayed electrical cord with exposed wires, which is plugged into a wall outlet. This observation points to a potential failure of the facility to:

Maintain all mechanical equipment in safe operating condition. (Correct answer)
Implement an effective pest control program.
Ensure the Life Safety Code is met for corridor width.
Provide adequate housekeeping and maintenance personnel.

Correct answer: Maintain all mechanical equipment in safe operating condition.

42 CFR §483.90 requires the facility to be equipped and maintained to protect the health and safety of residents, personnel, and the public. This includes ensuring all electrical equipment is in good repair and safe to operate. A frayed cord with exposed wires poses a significant risk of electric shock or fire.

Question 120: A respondent invites an adult neighbor into the room midway through the interview. What is the best response?

Pause the interview, explain the privacy requirement to the respondent, and ask the neighbor to wait elsewhere before resuming (Correct answer)
Continue the interview since the interview was already partially completed
Skip to non-sensitive questions only until the neighbor leaves on their own
End the interview immediately and classify it as a partial completion

Correct answer: Pause the interview, explain the privacy requirement to the respondent, and ask the neighbor to wait elsewhere before resuming

Interviewers must re-establish a private environment whenever it is disrupted, pausing rather than continuing or abandoning the interview.

Question 121: According to federal regulations, which of the following is a mandatory component of a facility's Infection Prevention and Control Program (IPCP)?

A mandatory 7-day isolation period for all new admissions.
A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases. (Correct answer)
A policy requiring all staff and residents to receive an annual influenza vaccine.
An on-site microbiology laboratory for rapid testing.

Correct answer: A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases.

Federal regulation 42 CFR §483.80 explicitly requires that the IPCP must include, at a minimum, a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for everyone in the facility.

Question 122: When a surveyor reviews a hospital's high-alert medication policy, which class of drugs would they most expect to see listed?

Laxatives and stool softeners
Antacids and vitamins
Anticoagulants, concentrated electrolytes, insulin, and opioids (Correct answer)
Antihistamines and topical corticosteroids

Correct answer: Anticoagulants, concentrated electrolytes, insulin, and opioids

ISMP's high-alert medication list includes anticoagulants, concentrated electrolytes, insulin, opioids, and other drugs with a high risk of causing significant patient harm if misused.

Question 123: To create an archeological map that shows the locations of historical artifacts. (Very accurate or not)

TRUE (Correct answer)
FALSE

Correct answer: TRUE

TRUE. Surveying is an accurate and widely used method for documenting the precise locations of historical artifacts on an archaeological site. Because it records exact relative positions, the statement is correct.

Question 124: A facility must care for each resident in a manner and in an environment that promotes the maintenance or enhancement of their quality of life. This includes treating residents with respect and dignity. Which of the following surveyor observations would most likely suggest a potential violation of this principle?

Staff members using facility-approved first names when addressing residents.
The facility has established set meal times for all residents in the main dining room.
A resident's urinary catheter bag is uncovered and visible to visitors in the hallway. (Correct answer)
A nurse quietly closes the door to a resident's room before providing personal care.

Correct answer: A resident's urinary catheter bag is uncovered and visible to visitors in the hallway.

Failing to cover a urinary catheter bag is a common example of a practice that can be demeaning and infringe upon a resident's dignity. Treating residents with respect and dignity is a core component of the Quality of Life regulations. Closing a door for privacy and using preferred names are signs of respecting dignity, and set meal times are a standard operational practice, provided individual needs can be accommodated.

Question 125: During a nutrition review, a surveyor notes a resident with a pressure ulcer has not had a nutritional assessment update in 6 months despite a significant change in condition. This is MOST likely a deficiency in:

Physician notification requirements
Comprehensive assessment/reassessment (F636) (Correct answer)
Medication management (F756)
Activities programming (F679)

Correct answer: Comprehensive assessment/reassessment (F636)

A significant change in condition such as a new pressure ulcer requires a reassessment under F636; failing to update the nutritional assessment violates this requirement.

Question 126: Which CMS F-tag under the revised Requirements of Participation specifically addresses freedom from abuse, neglect, and exploitation?

F550
F625
F600 (Correct answer)
F700

Correct answer: F600

F600 is the CMS F-tag that specifically addresses freedom from abuse, neglect, exploitation, and misappropriation of property under 42 CFR §483.12.

Question 127: Which scope level indicates that a deficiency affects only a limited number of residents and is not a widespread pattern?

Systemic
Widespread
Pattern
Isolated (Correct answer)

Correct answer: Isolated

An 'isolated' scope means the deficiency occurred in one or a small number of instances without a pattern.

Question 128: Creating a cadastral map that displays the borders of homes, farms, and other assets. (Alternative/True)

TRUE (Correct answer)
FALSE

Correct answer: TRUE

TRUE. A cadastral map's specific purpose is to document property boundaries and land ownership, showing the borders of homes, farms, and other assets. This is exactly what the statement describes, so it is correct.

Question 129: A surveyor reviews a facility's controlled substance records and finds a discrepancy between the count on record and the actual count in the cabinet. What is the FIRST required action by the facility?

Discharge the responsible nurse
Order a full pharmacy audit before taking action
Report the discrepancy per the facility's policy and notify the pharmacist and appropriate authorities (Correct answer)
Lock the medication cabinet and continue the survey

Correct answer: Report the discrepancy per the facility's policy and notify the pharmacist and appropriate authorities

Facilities must have policies requiring immediate reporting of controlled substance discrepancies to the pharmacist, administrator, and law enforcement or DEA as appropriate.

Question 130: What is the purpose of the facility's IJ removal plan?

To replace the Plan of Correction for all deficiencies
To describe the immediate actions taken to remove the jeopardy, which surveyors must verify onsite (Correct answer)
To request a waiver of civil money penalties
To dispute the IJ determination formally

Correct answer: To describe the immediate actions taken to remove the jeopardy, which surveyors must verify onsite

A removal plan lists the immediate actions the provider has taken or will take to remove the risk. Surveyors verify onsite that the plan has been implemented before determining the jeopardy is removed. A separate Plan of Correction is still needed for the remaining noncompliance.

Question 131: A nursing home resident has been diagnosed with Clostridioides difficile (C. diff). What is the MOST appropriate isolation precaution?

Airborne precautions with negative pressure room
Standard precautions only
Contact precautions with gown and gloves (Correct answer)
Droplet precautions with surgical mask

Correct answer: Contact precautions with gown and gloves

C. diff is transmitted via the fecal-oral route through spores on surfaces, requiring contact precautions including gown and gloves.

Question 132: Which of the following best describes an acceptable physical environment for a survey interview according to SMQT standards?

Any indoor location where both parties can be seated comfortably
A respondent's porch if indoor access is not offered
A quiet space with visual and auditory privacy from uninvolved third parties (Correct answer)
A public library reading room with other patrons nearby

Correct answer: A quiet space with visual and auditory privacy from uninvolved third parties

SMQT-compliant environments must provide both auditory and visual privacy to ensure respondents can answer freely without fear of being overheard or observed.

Question 133: Which of the following is a fundamental principle of the Quality of Life requirement (§483.24) that applies to all care and services provided to residents?

Ensuring the facility operates at full occupancy to maximize social interaction.
Prioritizing the facility's administrative convenience in care scheduling.
Attaining and maintaining the highest practicable physical, mental, and psychosocial well-being. (Correct answer)
Providing care that is identical for all residents to ensure fairness.

Correct answer: Attaining and maintaining the highest practicable physical, mental, and psychosocial well-being.

The core tenet of 42 CFR §483.24 is that each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's assessment and care plan. The other options conflict with the principles of individualized, person-centered care.

Question 134: When a PASRR Level II evaluation is required, which professional must conduct it?

A licensed social worker
The nursing facility's medical director
A registered nurse
A qualified mental health professional or intellectual disability specialist (Correct answer)

Correct answer: A qualified mental health professional or intellectual disability specialist

Level II evaluations must be performed by a qualified mental health professional or intellectual disability specialist as defined by the state.

Question 135: A resident informs a surveyor that they wish to file a grievance about the food quality but are afraid the kitchen staff will retaliate by giving them smaller portions. A surveyor should recognize that the facility must protect which of the following resident rights?

The right to be free from coercion, discrimination, and reprisal. (Correct answer)
The right to formulate an advance directive.
The right to retain and use personal possessions.
The right to choose a roommate.

Correct answer: The right to be free from coercion, discrimination, and reprisal.

Federal regulations at 42 CFR §483.10(b)(2) explicitly protect a resident's right to exercise their rights, including voicing grievances, without fear of interference, coercion, discrimination, or reprisal from the facility. The facility has a duty to ensure residents can complain without negative consequences.

Question 136: Under the OBRA framework, which document provides the foundation for identifying care planning 'triggers' that require further assessment?

The facility's quality improvement committee minutes
The Care Area Assessment (CAA) process initiated by MDS triggers (Correct answer)
The state inspection report from the prior survey
The resident's insurance pre-authorization form

Correct answer: The Care Area Assessment (CAA) process initiated by MDS triggers

The CAA process, triggered by specific MDS items, guides the interdisciplinary team in deciding which areas to address in the care plan.

Question 137: Which of the following findings would constitute a deficiency related to the Beers Criteria during an SMQT survey of a long-term care facility?

Administering acetaminophen for pain in an elderly resident
Using a beta-blocker for an elderly resident with heart failure
Ordering a multivitamin daily for a resident with poor appetite
Prescribing a benzodiazepine as a first-line hypnotic for a 78-year-old without documented clinical rationale (Correct answer)

Correct answer: Prescribing a benzodiazepine as a first-line hypnotic for a 78-year-old without documented clinical rationale

The Beers Criteria identifies benzodiazepines as potentially inappropriate for older adults; use without clinical justification or attempted alternatives is a common survey deficiency.

Question 138: A food service worker is observed using a cloth towel to wipe food contact surfaces between uses. Under food safety standards, this practice is:

Acceptable if the towel is color-coded for kitchen use
Acceptable only for dry food surfaces
Acceptable if the cloth is laundered daily
A violation because wiping cloths must be stored in sanitizer solution between uses (Correct answer)

Correct answer: A violation because wiping cloths must be stored in sanitizer solution between uses

FDA Food Code requires that wiping cloths used on food contact surfaces be kept in a sanitizer solution between uses to prevent bacterial contamination.

Question 139: A resident with dementia is non-verbal and unable to participate in their care planning meeting. To comply with person-centered care planning requirements, which of the following is the facility's BEST course of action?

Proceed with the care plan development without the resident's input, as it is not practicable.
Ensure the resident's legal representative or family member participates in the process, and that the plan reflects the resident's known preferences. (Correct answer)
Have the nursing staff who work closest with the resident make all care plan decisions.
Postpone the care planning meeting until the resident is able to communicate.

Correct answer: Ensure the resident's legal representative or family member participates in the process, and that the plan reflects the resident's known preferences.

Person-centered care requires that the facility actively involves the resident and/or their representative in the care planning process. When a resident cannot participate, the facility must include their representative to ensure the plan reflects the resident's values, preferences, and goals to the greatest extent possible.

Question 140: Which of the following scenarios constitutes a 'significant medication error' according to the Centers for Medicare & Medicaid Services (CMS) definition?

A resident is administered a medication to which they have a known, severe allergy, requiring emergency intervention. (Correct answer)
A resident's routine daily multivitamin is administered one hour after its scheduled time.
A nurse documents the administration of a medication in the wrong time slot in the Medication Administration Record (MAR).
A resident refuses one dose of a non-critical medication, and the refusal is properly documented.

Correct answer: A resident is administered a medication to which they have a known, severe allergy, requiring emergency intervention.

A significant medication error is defined as one which causes the resident discomfort or jeopardizes their health and safety. Administering a drug to a resident with a known severe allergy clearly jeopardizes their health and safety and has the potential for a life-threatening outcome.

Question 141: What triggers a Significant Change in Status Assessment (SCSA) under MDS requirements?

A change in roommate assignment
A major decline or improvement that will not return to baseline within 2 weeks (Correct answer)
Any new physician order
An emergency room visit

Correct answer: A major decline or improvement that will not return to baseline within 2 weeks

An SCSA is triggered when a resident experiences a major decline or improvement not expected to resolve within 2 weeks.

Question 142: Which of the following BEST describes the purpose of the Quality Indicator Survey (QIS) trigger system?

To identify areas of concern from MDS data that guide survey task focus (Correct answer)
To automatically generate citations without on-site verification
To randomly select which facilities are surveyed each year
To score each facility's overall star rating

Correct answer: To identify areas of concern from MDS data that guide survey task focus

QIS uses MDS-derived quality indicators to help surveyors prioritize which areas to investigate during an on-site survey.

Question 143: During a survey, a resident's care plan lists a documented allergy to penicillin, but the surveyor observes amoxicillin ordered and administered. What is the most likely deficiency?

Medication administered at the wrong time
Improper controlled substance handling
Failure to screen for cross-reactive allergies before prescribing a related beta-lactam antibiotic (Correct answer)
Failure to obtain informed consent for antibiotic use

Correct answer: Failure to screen for cross-reactive allergies before prescribing a related beta-lactam antibiotic

Amoxicillin is a penicillin-class beta-lactam; prescribing it to a penicillin-allergic patient without allergy reassessment or clinical justification is a medication safety deficiency.

Question 144: Which of the following best describes a 'significant change in condition' that would trigger an unscheduled care plan revision?

A resident's birthday preference change
A documented decline in two or more ADLs that is not expected to resolve (Correct answer)
A minor bruise from a fall with no ongoing issues
A single elevated blood pressure reading

Correct answer: A documented decline in two or more ADLs that is not expected to resolve

A significant change requiring MDS reassessment—such as decline in multiple ADLs—also triggers a comprehensive care plan update.

Question 145: When a resident's representative (not the resident) is the primary decision-maker, the surveyor should verify that:

A representative's authority supersedes all resident preferences without exception
The resident is still involved in care decisions to the extent of their ability and desire (Correct answer)
The facility communicates only with the representative and not the resident
The representative's decisions are reviewed monthly by the medical director

Correct answer: The resident is still involved in care decisions to the extent of their ability and desire

Even when a representative is involved, residents must be included in care decisions to the extent they are able and wish to participate.

Question 146: A surveyor is at a facility with an average daily occupancy of 85 residents. The Director of Nursing (DON), an RN, is assigned as the charge nurse for a specific unit every weekday from 7 a.m. to 3 p.m. This staffing assignment is:

Permitted, as long as the DON works full-time.
Not permitted, because the DON may only serve as a charge nurse in facilities with an average daily occupancy of 60 or fewer residents. (Correct answer)
Not permitted, because the DON can only be a charge nurse in a facility with a daily occupancy of 120 or fewer residents.
Permitted, because the DON is a qualified RN.

Correct answer: Not permitted, because the DON may only serve as a charge nurse in facilities with an average daily occupancy of 60 or fewer residents.

Federal regulation 42 CFR §483.35(b)(3) specifies that the Director of Nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents. Since this facility's occupancy is 85, this arrangement is a violation.

Question 147: During observation, a surveyor notices a CNA crushing a tablet that is labeled 'do not crush.' What regulation or standard is most directly implicated?

Resident rights regulations
Dietary supplement guidelines
Medication administration standards requiring medications to be given in the form prescribed (Correct answer)
Hand hygiene protocols

Correct answer: Medication administration standards requiring medications to be given in the form prescribed

Crushing a 'do not crush' medication (e.g., extended-release tablets) alters the dose form and delivery, violating medication administration standards and potentially harming the resident.

Question 148: During a survey, a resident tells a surveyor that staff skip her scheduled bath twice a week. This information is BEST classified as:

Sufficient standalone evidence for an immediate citation
Hearsay and therefore unusable
Confidential and cannot be included in the survey record
Interview data to be corroborated with observation and records (Correct answer)

Correct answer: Interview data to be corroborated with observation and records

Resident interviews are valid data sources that must be corroborated before a deficiency is cited.

Question 149: What is the primary reason SMQT standards require a private interview setting?

To protect respondent confidentiality and reduce social desirability bias in answers (Correct answer)
To ensure the interviewer's personal safety during the visit
To comply with local zoning laws regarding commercial activity in residences
To allow the interviewer to record answers without background noise interference

Correct answer: To protect respondent confidentiality and reduce social desirability bias in answers

A private setting protects confidentiality and removes social pressure that causes respondents to give answers they think others want to hear rather than truthful ones.

Question 150: Under CMS F-tag F803, a nursing facility's menus must be planned and followed with sufficient variety to meet residents' needs and preferences. What is the minimum number of meals that must be offered each day?

3 meals at set times only
3 meals plus snacks as needed (Correct answer)
2 meals plus snacks
4 meals with no snacks required

Correct answer: 3 meals plus snacks as needed

CMS requires at least three meals per day plus snacks between meals and at bedtime as needed to meet residents' nutritional needs.

Surveyor Minimum Qualifications Test (SMQT)

The SMQT is administered by CMS through PSI Services LLC to certify that state agency surveyors possess the minimum knowledge needed to conduct federal compliance surveys of long-term care facilities.

150

Questions

270 min

Time Limit

75%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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qsep.cms.gov — Test delivery, exam format, retake policy, score release, test dates, time limit, eligibility · verified Oct 2026