Surveyor Minimum Qualifications Test (SMQT) — Questions and Answers

Question 1: A plan's Quality of Life monitoring system uses only unannounced on-site visits to assess enrollee experience. A SMQT surveyor would most likely recommend adding which additional method?

Review of provider billing patterns
Review of provider credentialing files
Direct enrollee interviews conducted independently of plan staff (Correct answer)
Analysis of encounter data completeness rates

Correct answer: Direct enrollee interviews conducted independently of plan staff

Enrollees may not freely express concerns in front of plan staff, so independent interviews are essential for capturing the authentic enrollee perspective on Quality of Life.

Question 2: A pharmacist's monthly drug regimen review identifies that a resident is on two drugs with a clinically significant interaction but the physician has not been notified. What should the surveyor cite?

The charge nurse for administering both drugs
The prescribing physician for an unauthorized order
The pharmacist for failing to document the review
The facility for not ensuring the pharmacist's recommendation prompted a physician response (Correct answer)

Correct answer: The facility for not ensuring the pharmacist's recommendation prompted a physician response

Under 42 CFR §483.45(c)(4), the facility must ensure that the physician and director of nursing are informed of pharmacist recommendations and that there is a timely response.

Question 3: Under the CMS infection control regulations, what is required when a resident is placed on transmission-based precautions?

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

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 4: 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:

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

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 5: To investigate the infrastructure's availability and site circumstances.

route survey
preliminary survey
plane table survey
reconnaissance survey (Correct answer)

Correct answer: reconnaissance survey

A reconnaissance survey is the initial survey done to assess a site's feasibility, general conditions, and the availability of infrastructure before detailed work begins. A preliminary survey gathers more specific measured data later, while route and plane table surveys are particular techniques rather than this first feasibility check.

Question 6: A resident's attending physician has arranged for a nurse practitioner (NP), who is not an employee of the facility, to provide care. Which of the following describes a compliant schedule of required visits after the physician's initial visit?

The NP can only perform visits if the physician is physically present in the facility to supervise.
The NP performs the required visits at day 30 and day 60, and the physician performs the visit at day 90, alternating thereafter. (Correct answer)
The physician must personally perform all required visits; NPs cannot fulfill this requirement.
The physician must personally perform all required visits for the first 90 days; the NP can only perform visits after that.

Correct answer: The NP performs the required visits at day 30 and day 60, and the physician performs the visit at day 90, alternating thereafter.

42 CFR §483.30(c)(4) allows a physician, at their option, to alternate required visits with a qualified nurse practitioner, physician assistant, or clinical nurse specialist after the initial physician visit. The NP performing visits that alternate with the physician's personal visits is a compliant practice.

Question 7: 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)
Limit enrollee involvement in care conferences
Address enrollees in condescending tones when necessary
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 8: What should an interviewer note in their case record when the physical environment during an interview was suboptimal?

Record only that the interview was completed successfully
Note nothing, as environmental observations are not part of SMQT documentation
Mark the interview as invalid and request a replacement respondent
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 9: Which interdisciplinary team member is primarily responsible for coordinating the comprehensive care plan meeting?

The Social Worker
The attending physician
The Director of Nursing
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 10: Under OBRA regulations, which of the following constitutes 'involuntary seclusion' of a nursing home resident?

Placing a resident in an isolation room for medically necessary infection control purposes with physician orders
Requiring a resident to attend mandatory group therapy sessions as part of their care plan
Transferring a resident to a memory care unit based on documented physician orders and assessments
Confining a resident to their room against their will as a means of discipline without medical justification (Correct answer)

Correct answer: Confining a resident to their room against their will as a means of discipline without medical justification

Involuntary seclusion is the separation or confinement of a resident against their will without proper medical justification, used as discipline or for staff convenience.

Question 11: A resident shares information with a social worker about concerns with their care. The social worker discloses this information to other residents during a group meeting. This violates the resident's right to:

Refuse treatment
Confidentiality of personal information (Correct answer)
Participate in care planning
Freedom from restraint

Correct answer: Confidentiality of personal information

Disclosing a resident's private concerns to others without consent violates confidentiality protections under resident rights regulations.

Question 12: Under OBRA regulations, which of the following best describes a resident's right to receive visitors?

Visitors may be limited to immediate family members only
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)
Visiting hours are entirely within the facility's discretion

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 13: 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?

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

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 14: A surveyor notices that an LTSS plan's staff training curriculum does not include Quality of Life topics. What should the surveyor conclude?

This is acceptable since Quality of Life is self-evident to care workers
Staff training on Quality of Life is optional under federal Medicaid rules
This is a compliance gap because staff must be trained on Quality of Life standards to implement them (Correct answer)
Quality of Life training is only required for supervisors, not frontline staff

Correct answer: This is a compliance gap because staff must be trained on Quality of Life standards to implement them

Effective implementation of Quality of Life standards requires that all relevant staff receive training, so a gap in the curriculum is a compliance concern.

Question 15: A resident refuses the therapeutic diet ordered by the physician. After education on risks, the resident continues to refuse. The facility's CORRECT response under resident rights regulations is to:

Document the refusal and provide the resident's food preferences while informing the physician (Correct answer)
Enforce the diet as ordered by the physician
Withhold meals until the resident agrees to the therapeutic diet
Transfer the resident to acute care

Correct answer: Document the refusal and provide the resident's food preferences while informing the physician

Residents have the right to refuse treatment including therapeutic diets; the facility must document the refusal, notify the physician, and work to honor food preferences.

Question 16: 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
Transfer the resident to a facility that specializes in religious diets
Offer only vegetarian meals to all residents to avoid the issue
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 17: A respondent's young children are repeatedly running into the room and interrupting the interview. What should the interviewer do?

Ask the respondent if the children can be occupied elsewhere or if there is a quieter room available (Correct answer)
Ignore the interruptions and continue asking questions during brief breaks in activity
Shorten the questionnaire to reduce the number of interruptions
Reschedule the interview without offering any guidance about interview conditions

Correct answer: Ask the respondent if the children can be occupied elsewhere or if there is a quieter room available

Repeated interruptions compromise data quality and respondent focus, so the interviewer should proactively seek a better environment rather than simply enduring the disruption.

Question 18: 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:

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

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 19: When evaluating Quality of Life for LTSS enrollees, a surveyor should check that care plans include which of the following elements?

The plan's cost projections for each service
Enrollee's goals, preferred daily routines, and support preferences (Correct answer)
Provider performance scores for each assigned clinician
Only the enrollee's medical diagnoses and treatment history

Correct answer: Enrollee's goals, preferred daily routines, and support preferences

Comprehensive Quality of Life-focused care plans must capture the enrollee's personal goals, preferred routines, and how they want to receive support.

Question 20: 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?

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

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

The state inspection report from the prior survey
The facility's quality improvement committee minutes
The Care Area Assessment (CAA) process initiated by MDS triggers (Correct answer)
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 22: Which regulatory tag is associated with nursing home residents' rights to be free from abuse, neglect, and exploitation?

F758
F600 (Correct answer)
F812
F684

Correct answer: F600

F600 covers the requirement that residents are free from abuse, neglect, misappropriation, and exploitation.

Question 23: 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 24: What does 'EDM' stand for and what does it measure?

Error Detection Module — checks instrument calibration
Electronic Distance Measurement — measures slope distances using electromagnetic waves (Correct answer)
Electronic Data Management — manages field notes digitally
Elevation Difference Method — computes height using trigonometry

Correct answer: Electronic Distance Measurement — measures slope distances using electromagnetic waves

An EDM (Electronic Distance Measurement) device emits electromagnetic radiation (infrared or microwave) and measures the phase difference or travel time of the returned signal to compute slope distance.

Question 25: 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.
Accommodating resident preferences over physician's orders.
Ensuring menus are prepared in accordance with physician's orders. (Correct answer)
Procuring food from sources approved by local authorities.

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 26: Which scenario best illustrates unnecessary drug use as defined under F758 (unnecessary medications) in long-term care surveys?

Prescribing a diuretic for a resident with congestive heart failure
Continuing an antipsychotic for six months without a diagnosis-based indication or gradual dose reduction attempts (Correct answer)
Administering a statin to a resident with documented hyperlipidemia
Giving acetaminophen PRN for arthritis pain

Correct answer: Continuing an antipsychotic for six months without a diagnosis-based indication or gradual dose reduction attempts

F758 targets antipsychotics and other medications used without a valid indication, without dose reduction attempts, or for excessive duration beyond clinical need.

Question 27: In a bearing system, what does 'S 45° W' mean?

45° measured clockwise from south toward west (Correct answer)
45° measured counterclockwise from south toward west
45° measured clockwise from north
The line points due southwest at exactly 225° azimuth

Correct answer: 45° measured clockwise from south toward west

Bearings are read as an angle from either north or south toward either east or west; S 45° W means starting from south and rotating 45° toward west.

Question 28: Which MDS item set is used when a resident returns from a hospital stay under a Medicare Part A benefit?

Admission assessment
Return from Hospital tracking record (Correct answer)
Quarterly assessment
Significant Change in Status Assessment

Correct answer: Return from Hospital tracking record

A Return from Hospital tracking record is completed when a resident returns to the NF following a hospitalization during a Part A stay.

Question 29: A facility admits a resident under Medicare Part A. When must the first MDS assessment (5-Day PPS) be completed?

By day 3 of the Medicare stay
By day 7 of the Medicare stay
By day 14 of the Medicare stay
By day 5 of the Medicare stay (Correct answer)

Correct answer: By day 5 of the Medicare stay

The 5-Day PPS assessment must be completed by day 5 of the Medicare-covered stay to establish the initial payment classification.

Question 30: A surveyor reviews a resident's medical record and notes the attending physician has not documented a required interval visit but has signed off on all orders. What is the appropriate survey action?

Cite a deficiency for failure to meet physician visit frequency requirements (Correct answer)
Request clarification from the physician before determining deficiency
Cite only if the resident experienced an adverse outcome
No deficiency because the physician remained engaged via order signatures

Correct answer: Cite a deficiency for failure to meet physician visit frequency requirements

Order signatures do not substitute for the required face-to-face physician visits; a missing documented visit is a citable deficiency regardless of other physician activity.

Question 31: A surveyor finds that a resident's care plan lists a goal of 'resident will not fall' but lacks specific interventions. This is a deficiency because:

Care plans require measurable goals with corresponding interventions (Correct answer)
Only physicians may write fall-prevention goals
Falls goals are not required by regulation
Goals must be written in medical terminology

Correct answer: Care plans require measurable goals with corresponding interventions

Regulations require care plans to include measurable objectives and specific interventions to address identified problems.

Question 32: What is the purpose of an Informal Dispute Resolution (IDR) following a survey?

To determine the facility's fine amount for Immediate Jeopardy findings
To allow surveyors to add new citations after exit
To give facilities a formal opportunity to dispute cited deficiencies before they are finalized (Correct answer)
To schedule the next standard survey date

Correct answer: To give facilities a formal opportunity to dispute cited deficiencies before they are finalized

IDR is a post-survey process where facilities can present evidence challenging cited deficiencies.

Question 33: What is the primary, official purpose of the Form CMS-2567, 'Statement of Deficiencies'?

To communicate the specific evidence of non-compliance with federal regulations. (Correct answer)
To provide consultative advice to the facility on best practices.
To document the survey team's daily notes and observations.
To serve as a punitive measure against non-compliant facilities.

Correct answer: To communicate the specific evidence of non-compliance with federal regulations.

The Form CMS-2567 is the official legal document used to record how a facility failed to meet federal requirements. It must contain specific, evidence-based findings to support each deficiency cited and serves as the basis for the facility to create a Plan of Correction. The form explicitly should not contain consultative remarks or advice.

Question 34: 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:

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

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 35: Which of the following triggers an Immediate Jeopardy (IJ) declaration during a survey?

Three or more residents with the same care plan deficiency
Failure to post the most recent survey results
A documentation error found in a single resident's chart
A situation where a facility's noncompliance has caused or is likely to cause serious injury or death (Correct answer)

Correct answer: A situation where a facility's noncompliance has caused or is likely to cause serious injury or death

Immediate jeopardy requires that noncompliance caused or is likely to cause serious harm, injury, impairment, or death.

Question 36: A facility contracts with a telemedicine physician to fulfill all required physician visit obligations. Under current CMS guidance, this arrangement:

Is never acceptable because visits must always be in-person
May be acceptable if the state permits telemedicine visits to satisfy face-to-face requirements (Correct answer)
Is fully acceptable under all CMS conditions without state-level consideration
Is acceptable only for the initial admission visit

Correct answer: May be acceptable if the state permits telemedicine visits to satisfy face-to-face requirements

CMS has recognized telemedicine visits may satisfy physician visit requirements, but acceptability depends on applicable state law and the visit meeting required evaluation standards.

Question 37: According to federal regulations at 42 CFR §483.90(d), a facility's resident call system must be accessible from which specific locations?

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

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 38: The 'universe' in the context of a nursing home survey refers to:

The full list of applicable federal regulations
The total population from which the resident sample is drawn (Correct answer)
All deficiencies cited in the past three surveys
All residents currently admitted to the facility

Correct answer: The total population from which the resident sample is drawn

The universe is the entire eligible population used to determine the appropriate resident sample size and selection.

Question 39: A resident's care plan includes an intervention of 'encourage fluids.' A surveyor would flag this intervention because:

It lacks specificity—amount, frequency, and method are undefined (Correct answer)
The term 'encourage' is prohibited by CMS guidance
Only dietitians may write fluid interventions
Fluid interventions require a physician order

Correct answer: It lacks specificity—amount, frequency, and method are undefined

Interventions must be specific enough for any staff member to implement consistently; 'encourage fluids' does not define target volume, frequency, or approach.

Question 40: Which of the following environmental conditions should an interviewer prioritize FIRST when setting up an in-person interview?

Verifying the room temperature is comfortable for both parties
Confirming there is adequate lighting for reading survey materials
Checking that there is a flat surface for writing if a paper questionnaire is used
Ensuring the space provides visual and auditory privacy from all non-participants (Correct answer)

Correct answer: Ensuring the space provides visual and auditory privacy from all non-participants

Privacy is the foundational environmental requirement in SMQT standards because it directly determines the validity and reliability of responses to all survey items.

Question 41: When conducting a telephone interview, which physical environment standard on the INTERVIEWER'S end still applies?

The interviewer should be in a public location to ensure accountability
The interviewer must be in a room with natural light for reading survey materials
Phone interviews have no physical environment requirements since the respondent cannot see the interviewer
The interviewer must work in a quiet space free from background noise and distractions (Correct answer)

Correct answer: The interviewer must work in a quiet space free from background noise and distractions

Even in telephone surveys, interviewers must work in quiet, distraction-free environments to maintain professional conduct and avoid background noise that could confuse respondents.

Question 42: A consultant pharmacist, during a monthly drug regimen review, identifies that a resident is prescribed two medications with a known significant drug-to-drug interaction that could cause serious harm. According to 42 CFR §483.45, what is the pharmacist's required action after identifying this irregularity?

Document the finding for review at the next quarterly Quality Assurance meeting.
Contact the resident's family to inform them of the potential risk.
Report the finding to the facility's administrator and medical director.
Report the irregularity to the attending physician and the director of nursing. (Correct answer)

Correct answer: Report the irregularity to the attending physician and the director of nursing.

According to 42 CFR §483.45(c)(4), the pharmacist must report any identified irregularities to the attending physician and the facility's director of nursing. This ensures that those with the authority to make clinical changes are promptly informed to take necessary action.

Question 43: A respondent lives in a single-room dwelling with multiple family members always present. What is the MOST appropriate action?

Ask family members to go outside during the interview
Arrange an alternative location such as a private room at a community center or library (Correct answer)
Convert the interview to a self-administered mail questionnaire automatically
Proceed with the interview and note that a private environment was unavailable

Correct answer: Arrange an alternative location such as a private room at a community center or library

When a respondent's home cannot provide privacy, interviewers are expected to arrange mutually agreeable alternative locations that meet environmental standards.

Question 44: A SMQT surveyor finds that a plan's Quality of Life assessment tool focuses exclusively on physical health deficits. What is the primary problem with this approach?

Physical assessments must be conducted only by physicians under federal rules
It ignores psychological, social, and environmental dimensions of well-being (Correct answer)
It violates HIPAA because physical data is too sensitive
Physical health is irrelevant to Quality of Life assessments

Correct answer: It ignores psychological, social, and environmental dimensions of well-being

Quality of Life encompasses psychological well-being, social relationships, and environment—not just physical health—so a deficit-only physical tool is incomplete.

Question 45: When reviewing a facility's diet order system, a surveyor finds that diet orders are changed by the charge nurse without a physician's countersignature. Under federal regulations, diet orders:

May be changed by any licensed nurse in response to resident preference
Must be ordered by a physician or authorized practitioner and documented in the medical record (Correct answer)
Can be changed by a CDM if approved by the dietary director
Are optional for residents who are cognitively intact

Correct answer: Must be ordered by a physician or authorized practitioner and documented in the medical record

Therapeutic and regular diet orders must be physician-ordered (or by an authorized practitioner) and properly documented, as they are medical orders affecting health.

Question 46: A facility's policy allows nursing staff to accept verbal orders for Schedule II controlled substances. How should a surveyor evaluate this practice?

Permissible only in emergencies per state law
A deficiency because DEA regulations prohibit verbal orders for Schedule II substances except in emergencies (Correct answer)
Acceptable if the physician countersigns within 24 hours
Compliant as long as two nurses witness the order

Correct answer: A deficiency because DEA regulations prohibit verbal orders for Schedule II substances except in emergencies

DEA regulations generally prohibit verbal (phone) orders for Schedule II controlled substances except in genuine emergency situations with immediate follow-up written order.

Question 47: Which of the following best represents a person-centered care plan approach as emphasized in current CMS regulations?

Goals reflecting the resident's own preferences, strengths, and life history (Correct answer)
Goals approved only after family consent overrides resident choice
Goals focused solely on reducing clinical risk regardless of resident preference
Goals written exclusively by clinical staff using standardized templates

Correct answer: Goals reflecting the resident's own preferences, strengths, and life history

CMS Phase 2 and 3 rules emphasize individualized, person-centered care plans that incorporate resident preferences, values, and goals.

Question 48: A facility experienced a bloodborne pathogen exposure incident involving a staff member. Which action is REQUIRED under OSHA's Bloodborne Pathogen Standard?

Reporting the incident to CMS within 24 hours
Replacing all needles in the facility with new brand products
Immediately terminating the employee for unsafe practice
Providing the exposed employee with post-exposure evaluation and follow-up at no cost (Correct answer)

Correct answer: Providing the exposed employee with post-exposure evaluation and follow-up at no cost

OSHA's Bloodborne Pathogen Standard requires employers to provide free post-exposure evaluation, testing, and follow-up to exposed employees.

Question 49: 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:

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

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 50: A surveyor observes unlabeled syringes prefilled with insulin sitting on a medication cart. What is the most critical immediate concern?

Improper sharps container placement
Risk of wrong-patient or wrong-dose medication error due to missing identification (Correct answer)
Insulin waste without documentation
Lack of refrigeration for the syringes

Correct answer: Risk of wrong-patient or wrong-dose medication error due to missing identification

Unlabeled medications or syringes create a serious risk of medication errors, including administration to the wrong patient or at the wrong dose.

Question 51: When a surveyor cites a facility for a deficiency, the citation must include which of the following?

The name of the staff member responsible
The proposed corrective action
The administrator's signature of receipt
The regulatory tag number and scope/severity level (Correct answer)

Correct answer: The regulatory tag number and scope/severity level

Every citation must reference the applicable regulatory tag number and be assigned a scope and severity level.

Question 52: Which of the following best describes 'neglect' as defined under the Requirements of Participation for long-term care facilities?

Failure of the facility, its employees, or service providers to provide goods and services necessary to avoid physical harm, pain, mental anguish, or emotional distress (Correct answer)
Willful infliction of injury or unreasonable confinement by a staff member against a resident
Any verbal or written communication that causes a resident emotional distress
The taking, misappropriation, or unauthorized use of a resident's personal belongings or finances

Correct answer: Failure of the facility, its employees, or service providers to provide goods and services necessary to avoid physical harm, pain, mental anguish, or emotional distress

Neglect is defined as the failure to provide necessary goods and services, distinguishing it from abuse, which requires a willful harmful act.

Question 53: Which surveying instrument is that in the picture?

Receiver
Rotating laser Assembly (Correct answer)
Receiver damp
Stationary laser

Correct answer: Rotating laser Assembly

A rotating laser assembly is the main unit that spins its laser diode to project a continuous level plane of light. A receiver only detects the beam, a 'stationary laser' would not sweep a plane, and 'receiver damp' is not a real instrument, so the assembly is the emitting device shown.

Question 54: Which type of survey establishes the exact boundaries of a parcel of land?

Topographic survey
Hydrographic survey
Cadastral survey (Correct answer)
Geodetic survey

Correct answer: Cadastral survey

A cadastral survey defines and documents land boundaries for legal ownership and taxation purposes.

Question 55: Which scope level indicates that a deficiency affects only a limited number of residents and is not a widespread pattern?

Systemic
Pattern
Isolated (Correct answer)
Widespread

Correct answer: Isolated

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

Question 56: 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?

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

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.

Question 57: A resident asks to use the telephone in private. The facility's only phone is in the nurses' station where staff work. The facility should:

Provide reasonable accommodations for private telephone access (Correct answer)
Deny the request since the phone is a staff tool
Restrict calls to scheduled visiting hours
Allow the call only if a staff member is present for safety

Correct answer: Provide reasonable accommodations for private telephone access

Residents have the right to private telephone communication, and facilities must make reasonable accommodations to facilitate this.

Question 58: 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)
Clinical oversight
Care coordination
Utilization management

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 59: 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?

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)
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.

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 60: What is 'differential leveling' used to determine?

Horizontal distances between two points
Elevation differences between two or more points (Correct answer)
Magnetic declination at a site
Deflection angles along a traverse

Correct answer: Elevation differences between two or more points

Differential leveling uses a level instrument and rod to determine the difference in elevation between points.

Question 61: A resident wants to send and receive personal mail without interference. Under CMS regulations, the facility:

Must permit the resident to send and receive mail unopened (Correct answer)
Can hold mail until a family member is present to assist
May read outgoing mail to ensure it does not contain complaints
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 62: A surveyor discovers that a facility failed to investigate and report an allegation of resident-to-resident abuse. The MOST appropriate action is to:

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

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 63: During a survey, a resident tells the surveyor she was never told about her care plan or invited to participate in care conferences. This is a potential violation of which resident right?

Right to a private room
Right to privacy
Right to refuse all medications
Right to participate in care planning and treatment decisions (Correct answer)

Correct answer: Right to participate in care planning and treatment decisions

Residents have a federal right to be informed about and participate in their care planning and treatment decisions under 42 CFR §483.10.

Question 64: A facility's food safety log shows that a steam table was holding mashed potatoes at 130°F during lunch service. The required minimum hot holding temperature for cooked foods is:

150°F
130°F
135°F (Correct answer)
145°F

Correct answer: 135°F

The FDA Food Code requires hot foods to be held at 135°F or above to prevent bacterial growth in the temperature danger zone.

Question 65: A surveyor reviews MDS Section GG to evaluate a resident's functional abilities. What does Section GG primarily capture?

Skin integrity and wound status
Behavioral symptom frequency
Self-care and mobility functional abilities used in Medicare payment and quality reporting (Correct answer)
Nutritional intake and weight trends

Correct answer: Self-care and mobility functional abilities used in Medicare payment and quality reporting

Section GG captures functional abilities related to self-care and mobility, which are used for Medicare SNF payment classification and quality measure reporting.

Question 66: What is the PRIMARY purpose of an infection control risk assessment (ICRA) in a long-term care facility?

To document past infection outbreaks for regulatory compliance
To compare the facility's infection rates against national benchmarks
To identify and prioritize infection risks specific to the facility and guide prevention strategies (Correct answer)
To calculate the facility's annual infection rate for CMS reporting

Correct answer: To identify and prioritize infection risks specific to the facility and guide prevention strategies

An ICRA proactively identifies facility-specific vulnerabilities so the infection prevention program can target resources and interventions appropriately.

Question 67: 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
An isolated verbal disagreement that does not rise to the level of a regulatory citation
An appropriate facility policy used to maintain order and manage difficult residents
Retaliation against a resident for exercising their rights, which constitutes a form of prohibited abuse or intimidation (Correct answer)

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 68: A resident's PASRR Level II evaluation concludes specialized services are needed. Who is responsible for ensuring those services are provided?

The state mental health authority, coordinated with the nursing facility (Correct answer)
The Centers for Medicare & Medicaid Services directly
The resident's family members
The hospital that referred the resident

Correct answer: The state mental health authority, coordinated with the nursing facility

The state mental health or intellectual disability authority is responsible for ensuring specialized services are arranged and delivered in coordination with the NF.

Question 69: Which of the following best defines 'horizontal distance' in surveying?

The distance measured with a laser EDM regardless of terrain
The arc length along the Earth's curved surface
The distance measured along the slope between two points
The straight-line distance projected onto a level plane between two points (Correct answer)

Correct answer: The straight-line distance projected onto a level plane between two points

Horizontal distance is the projection of the slope distance onto a horizontal plane, which is required for accurate area calculations and plat preparation.

Question 70: Which scenario best demonstrates a systemic care planning deficiency versus an isolated individual deficiency?

One resident's care plan is missing a dietary goal
Multiple residents' care plans lack psychosocial goals despite documented depression diagnoses (Correct answer)
One care plan goal was not updated after a minor medication change
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 71: Which of the following findings would constitute a deficiency related to the Beers Criteria during an SMQT survey of a long-term care facility?

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)
Using a beta-blocker for an elderly resident with heart failure
Administering acetaminophen for pain in an elderly resident

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 72: A surveyor notes that a facility serves its evening meal at 5:00 p.m. and breakfast the next day at 8:00 a.m. The facility does not offer a routine bedtime snack. According to federal regulations regarding the frequency of meals, how should this practice be cited?

Compliant, as the time span is less than 16 hours.
Compliant, as long as a resident group has agreed to the meal span.
Deficient, because the time between the evening meal and breakfast exceeds 14 hours. (Correct answer)
Deficient, because meals are not served at traditional times.

Correct answer: Deficient, because the time between the evening meal and breakfast exceeds 14 hours.

Federal regulation 42 CFR §483.60(f)(2) states there must be no more than 14 hours between a substantial evening meal and breakfast the following day. The time between 5:00 p.m. and 8:00 a.m. is 15 hours. The exception of up to 16 hours is only permitted if a nourishing snack is provided at bedtime. Since no snack is offered, the facility is non-compliant.

Question 73: During an entrance conference, what is the primary purpose of the surveyor's opening statement?

To explain the survey process and team composition to facility leadership (Correct answer)
To collect staff signatures on disclosure forms
To conduct the initial medication pass observation
To review the previous survey's Plan of Correction

Correct answer: To explain the survey process and team composition to facility leadership

The entrance conference orients facility leadership to the survey team, purpose, and general process.

Question 74: Which kind of survey is shown in the image?

Plane
Geodetic
Topographic (Correct answer)
Dimensional

Correct answer: Topographic

A map showing contour lines plus natural and man-made features like rivers, roads, and buildings is a topographic survey. Dimensional is not a standard survey type, while geodetic (large-scale, curvature-based) and plane (flat-assumption) describe scale and method, not the feature-mapping shown in the image.

Question 75: 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:

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

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 76: _______________________ 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.

G.P.S
Topographic
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 77: 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:

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

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 78: 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?

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

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

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

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 81: Which of the following scenarios best demonstrates full compliance with SMQT physical environment standards?

An interview completed in a parked car on a residential street with windows up
A respondent and interviewer seated alone in a closed-door room with no audio devices recording and no third parties nearby (Correct answer)
A telephone interview conducted by an interviewer in an open-plan office with cubicle partitions
An interviewer conducting questions in a respondent's living room while the respondent's adult child reads quietly in the corner

Correct answer: A respondent and interviewer seated alone in a closed-door room with no audio devices recording and no third parties nearby

A closed, private room with only the respondent and interviewer present and no recording devices satisfies all core SMQT environmental standards simultaneously.

Question 82: A surveyor is reviewing a resident's comprehensive care plan. Which of the following elements is required to be included according to federal regulations?

A statement signed by the resident's physician agreeing to all aspects of the plan.
The resident's preference for a private room, regardless of availability.
A detailed list of all family members' contact information.
Measurable objectives and timeframes to meet the resident's needs. (Correct answer)

Correct answer: Measurable objectives and timeframes to meet the resident's needs.

According to 42 CFR §483.21, the comprehensive care plan must include measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs identified in the comprehensive assessment. While resident preferences and physician input are crucial, the specific requirement is for measurable goals and timelines.

Question 83: Under OBRA regulations, within how many days of admission must a comprehensive care plan be completed for a long-term care resident?

14 days
30 days
7 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 84: Which of the following is the correct order of steps when a surveyor identifies a potential Immediate Jeopardy situation?

Exit the survey immediately and return with law enforcement
Document the finding and wait until the exit conference to inform the facility
Notify the team coordinator, confirm IJ criteria are met, inform facility leadership, and require immediate removal of jeopardy (Correct answer)
Cite the deficiency, notify the state agency, then inform the facility

Correct answer: Notify the team coordinator, confirm IJ criteria are met, inform facility leadership, and require immediate removal of jeopardy

IJ protocol requires team consultation to confirm criteria, followed by immediate notification to facility leadership so jeopardy is removed as quickly as possible.

Question 85: Under resident rights regulations, a resident's right to privacy during personal care means:

Privacy applies only when visitors are present in the facility
Privacy is only required if the resident requests it verbally
The facility may use open-bay treatment areas if staffing is limited
Staff must ensure doors are closed and the resident is draped appropriately during care (Correct answer)

Correct answer: Staff must ensure doors are closed and the resident is draped appropriately during care

Residents have the right to privacy during personal care, treatment, and bathing, which requires appropriate draping and ensuring doors or curtains are closed.

Question 86: Which finding would indicate that a facility's QAPI program is effectively integrated with its infection prevention program?

Infection trends are analyzed at QAPI meetings and result in documented performance improvement projects (Correct answer)
The facility purchases new PPE each year regardless of infection rates
Hand hygiene audits are conducted but results are never shared with staff
Infection data is collected but reviewed only by the infection preventionist privately

Correct answer: Infection trends are analyzed at QAPI meetings and result in documented performance improvement projects

Effective integration means infection data drives QAPI performance improvement projects with documented goals, interventions, and outcomes.

Question 87: Which of the following best describes the role of natural supports in Quality of Life requirements for LTSS enrollees?

Natural supports are recognized as part of the enrollee's support network alongside formal services (Correct answer)
Plans are prohibited from including natural supports in care plans
Natural supports are only relevant for enrollees who lack family members
Natural supports replace paid services so plans can reduce costs

Correct answer: Natural supports are recognized as part of the enrollee's support network alongside formal services

Quality of Life standards recognize that family, friends, and community connections complement formal services and should be incorporated into the overall support plan.

Question 88: During a SMQT survey, which finding would indicate a plan is NOT meeting Quality of Life privacy requirements?

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

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 89: The 'rod reading' in differential leveling is the value observed on the:

Horizontal circle of the level instrument
Tape stretched between two monuments
Vertical circle of the theodolite
Stadia rod held vertically at a survey point (Correct answer)

Correct answer: Stadia rod held vertically at a survey point

The rod (or level rod) is a graduated staff held vertically at a point, and its reading through the level telescope gives the height of the instrument above that point.

Question 90: 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 91: What kind of surveying tool is that in the photo?

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

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 92: What should an interviewer do if they discover upon arrival that the pre-selected interview location has been double-booked with another event?

Conduct the interview in a hallway since it is technically separate from the event
Ask the event organizer for a brief break in their activity to use the room
Conduct the interview outside the building regardless of environmental conditions
Quickly identify an alternative private space in the same building or reschedule with the respondent for the earliest available time (Correct answer)

Correct answer: Quickly identify an alternative private space in the same building or reschedule with the respondent for the earliest available time

Interviewers must be adaptable problem-solvers who find compliant alternatives rather than compromising environmental standards due to logistical setbacks.

Question 93: 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 resident's managed care organization
The local health department
The state survey agency acting on behalf of CMS (Correct answer)
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 94: What does the term 'azimuth' describe in surveying?

The bearing of a line measured from the south pole
A horizontal angle measured clockwise from north (0°) through 360° (Correct answer)
The vertical angle from the horizon to a celestial body
The difference in elevation between two points

Correct answer: A horizontal angle measured clockwise from north (0°) through 360°

An azimuth is a horizontal direction measured clockwise from a reference meridian (usually north) ranging from 0° to 360°.

Question 95: What is the primary regulatory purpose of conducting background checks on prospective nursing facility employees?

To verify the applicant's educational credentials and professional licensure status
To assess the applicant's credit history and overall financial reliability
To identify individuals with a prior history of abuse, neglect, or financial exploitation of vulnerable adults (Correct answer)
To confirm the accuracy of the applicant's stated employment history and professional references

Correct answer: To identify individuals with a prior history of abuse, neglect, or financial exploitation of vulnerable adults

Background checks are primarily required to screen out individuals with a documented history of abuse, neglect, or exploitation, protecting residents from known risk factors.

Question 96: Which MDS section is used to document a resident's skin condition, including pressure injuries?

Section N
Section I
Section G
Section M (Correct answer)

Correct answer: Section M

Section M (Skin Conditions) of the MDS captures pressure injuries, skin treatments, and other skin integrity data.

Question 97: 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 and exclude fall interventions since the resident refused
Override the refusal because the resident lacks decision-making capacity
Document refusal, offer alternatives, and include all feasible interventions the resident will accept (Correct answer)
Contact state authorities before proceeding

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

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 99: 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:

38°F
50°F
41°F (Correct answer)
45°F

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

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

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 101: During a medication pass observation, a surveyor notes a nurse administering a medication that does not appear on the current Medication Administration Record. The nurse states the physician called in a change. What is the immediate concern?

The physician should be present for any medication change
This is acceptable if the nurse documents after administration
The nurse should have refused to administer any unwritten order
The order was not properly documented before administration, creating a medication safety risk (Correct answer)

Correct answer: The order was not properly documented before administration, creating a medication safety risk

Medications must not be administered before verbal orders are received, recorded, and authenticated; administering without an MAR entry represents a medication safety and documentation deficiency.

Question 102: In surveying, what is a 'backsight'?

A check measurement repeated at the end of a traverse
A measurement taken in the forward direction
A measurement taken toward the rear of the survey line to a known point (Correct answer)
An observation of the magnetic north

Correct answer: A measurement taken toward the rear of the survey line to a known point

A backsight is a rod or angle reading taken on a point of known elevation or position, used to establish the instrument's position or elevation.

Question 103: A resident who is cognitively intact asks to manage their own personal finances. Under resident rights regulations, the facility must:

Appoint a staff member to co-manage the resident's funds
Hold all funds in a facility trust account automatically
Require the family to serve as financial representative
Allow the resident to manage their own financial affairs (Correct answer)

Correct answer: Allow the resident to manage their own financial affairs

Residents have the right to manage their own financial affairs, and facilities cannot require residents to deposit funds with the facility.

Question 104: A surveyor observes a nurse reusing a single-dose vial of insulin for multiple residents. This practice violates which infection control principle?

Hand hygiene compliance
Safe injection practices to prevent bloodborne pathogen transmission (Correct answer)
Proper medication storage temperature requirements
Controlled substance documentation procedures

Correct answer: Safe injection practices to prevent bloodborne pathogen transmission

Single-dose vials must never be used for more than one patient, as this can transmit bloodborne pathogens like hepatitis B and C.

Question 105: A supervisor reviews a completed case and finds that the interviewer conducted the entire survey in a household kitchen while the respondent's roommate cooked nearby. What is the most likely quality concern raised?

The kitchen background noise may have caused the interviewer to mishear and misrecord some answers
The kitchen environment may have biased the respondent toward food-related topics in open-ended responses
The respondent may have been distracted by cooking smells and unable to concentrate on questions
Responses to sensitive questions may be systematically underreported due to lack of privacy from the roommate (Correct answer)

Correct answer: Responses to sensitive questions may be systematically underreported due to lack of privacy from the roommate

A third party present in the interview space is the primary data quality concern because it directly threatens respondent honesty on sensitive items through social desirability pressure.

Question 106: When evaluating a facility's use of physical restraints, a surveyor should look for evidence that:

The least restrictive alternative was used, with informed consent and ongoing reassessment (Correct answer)
Restraints are acceptable if family members provide written authorization
A physician order alone is sufficient to justify ongoing restraint use
Restraints applied for staff convenience are permissible if reviewed monthly

Correct answer: The least restrictive alternative was used, with informed consent and ongoing reassessment

Restraint use requires that the least restrictive alternative is attempted, informed consent is obtained, and the need is regularly reassessed.

Question 107: How do Quality of Life standards interact with an enrollee's grievance rights in Medicaid managed care?

Grievances about Quality of Life are handled by state courts, not the plan
Enrollees can file grievances specifically when Quality of Life standards are not met (Correct answer)
Only clinical grievances about medical treatment are allowed under federal rules
Grievance rights are separate and do not relate to Quality of Life

Correct answer: Enrollees can file grievances specifically when Quality of Life standards are not met

Enrollees have the right to file grievances when they believe the plan has failed to meet Quality of Life standards, and plans must have processes to address such complaints.

Question 108: Which situation would MOST likely indicate a failure of a long-term care facility's catheter-associated urinary tract infection (CAUTI) prevention program?

Use of a closed catheter drainage system
Catheter bags stored below bladder level
No documented daily assessment of catheter necessity (Correct answer)
Residents with catheters kept in private rooms

Correct answer: No documented daily assessment of catheter necessity

Daily assessment of continued catheter necessity is a core CAUTI prevention measure; absence of documentation suggests the program is not functioning.

Question 109: A facility's infection preventionist reports a cluster of three urinary tract infections in a single unit over two weeks. What is the surveyor's FIRST step in evaluating this situation?

Review the dietary department's food handling logs
Immediately cite the facility for an infection outbreak
Determine whether the facility identified the cluster and initiated an investigation (Correct answer)
Check whether the facility purchased new urinary catheters

Correct answer: Determine whether the facility identified the cluster and initiated an investigation

Surveyors must assess whether the facility detected the cluster and responded with an appropriate investigation per its QAPI and infection control program.

Question 110: A surveyor notes that a resident's prescribed eye drops are being stored in a medication refrigerator alongside staff food items. The eye drops are in their original, labeled container. This practice fails to comply with which aspect of medication services?

Proper temperature control.
Procedures for medication disposal.
Sanitary storage and prevention of contamination. (Correct answer)
Administration by licensed personnel only.

Correct answer: Sanitary storage and prevention of contamination.

While the medication is refrigerated (addressing temperature), storing it with food items creates a significant risk of contamination for both the food and the medication. Pharmacy standards and survey guidance require that refrigerators used for medication storage be dedicated to that purpose only, ensuring sanitary conditions and preventing cross-contamination.

Question 111: 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 112: A resident with a serious mental illness (SMI) is identified during PASRR Level I. Which statement is correct?

The admitting physician waives the Level II requirement
A Level II evaluation must be completed before admission (Correct answer)
The resident may not be admitted to a NF under any circumstances
The resident is automatically eligible for specialized services in the NF

Correct answer: A Level II evaluation must be completed before admission

A positive Level I screen for SMI requires a Level II evaluation before or shortly after admission to determine appropriate placement and services.

Question 113: 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 114: When computing latitudes and departures in a traverse, 'latitude' refers to:

The east-west component of a traverse course
The geographic latitude of the survey point
The north-south component of a traverse course (Correct answer)
The vertical component of a slope measurement

Correct answer: The north-south component of a traverse course

In traverse calculations, latitude is the projection of a course onto the north-south axis (positive northward, negative southward), while departure is the projection onto the east-west axis.

Question 115: Which of the following scenarios constitutes a 'significant medication error' according to the Centers for Medicare & Medicaid Services (CMS) definition?

A nurse documents the administration of a medication in the wrong time slot in the Medication Administration Record (MAR).
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 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 116: What does the term 'medication reconciliation' specifically require at care transitions in a surveyed facility?

Checking that the medication room stock matches the pharmacy's invoice
Confirming that the pharmacist reviews orders once a month
Comparing a patient's medication orders across transitions to identify discrepancies such as omissions, duplications, or interactions (Correct answer)
Ensuring all medications are dispensed in unit-dose packaging

Correct answer: Comparing a patient's medication orders across transitions to identify discrepancies such as omissions, duplications, or interactions

Medication reconciliation is the process of comparing a patient's medication orders to all medications the patient was taking to avoid errors at admission, transfer, or discharge.

Question 117: A hospital surveyor observes that expired medications are stored alongside current stock in a medication room. What type of deficiency is this?

Dietary services deficiency
Housekeeping deficiency
Infection control deficiency
Pharmaceutical services deficiency related to proper storage and removal of outdated drugs (Correct answer)

Correct answer: Pharmaceutical services deficiency related to proper storage and removal of outdated drugs

Facilities must segregate and promptly remove expired medications from active stock to prevent accidental administration.

Question 118: A resident's right to vote in federal, state, and local elections is:

Forfeited upon admission to a nursing facility
Only applicable if the resident was registered before admission
Preserved under the resident rights regulations (Correct answer)
Contingent on a physician's determination of cognitive capacity

Correct answer: Preserved under the resident rights regulations

Residents retain the right to vote and facilities must accommodate this right, including assisting with absentee ballot requests.

Question 119: The term 'horizontal distance' in surveying refers to:

The distance measured along the ground surface
The straight-line distance corrected for atmospheric refraction only
The slope distance measured directly between two points
The distance projected onto a horizontal plane, independent of elevation change (Correct answer)

Correct answer: The distance projected onto a horizontal plane, independent of elevation change

Horizontal distance is the distance between two points as projected onto a horizontal plane, used for area calculations and plats regardless of terrain slope.

Question 120: Which section of the MDS captures a resident's cognitive skills for daily decision-making?

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

Correct answer: Section C

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

Question 121: The closed record review task during a nursing home survey examines records of residents who:

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

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

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

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 123: Which type of personal protective equipment (PPE) is required for a healthcare worker performing bronchoscopy or suctioning on a resident with known or suspected influenza?

Standard precautions with no additional PPE needed
Surgical mask, gown, and gloves
Gloves and gown only
N95 respirator, eye protection, gown, and gloves (Correct answer)

Correct answer: N95 respirator, eye protection, gown, and gloves

Aerosol-generating procedures with influenza patients require airborne-level respiratory protection (N95), eye protection, gown, and gloves.

Question 124: Under federal regulations, how frequently must a nursing facility review and revise a resident's comprehensive care plan?

Annually
Every 6 months
Every 90 days or after a significant change (Correct answer)
Only when the resident requests it

Correct answer: Every 90 days or after a significant change

CMS requires care plans to be reviewed and revised quarterly or following a significant change in the resident's condition.

Question 125: 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?

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

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 126: The Resident Assessment Instrument (RAI) process is mandated by CMS to ensure a comprehensive and standardized assessment. Which of the following lists the three required components of the RAI?

The Physician's Orders, Nursing Notes, and the Medication Administration Record.
The Minimum Data Set (MDS), the Care Area Assessments (CAAs), and the RAI Utilization Guidelines. (Correct answer)
The Baseline Care Plan, the Comprehensive Care Plan, and the Discharge Summary.
The PASRR Level I, the PASRR Level II, and the Specialized Services Plan.

Correct answer: The Minimum Data Set (MDS), the Care Area Assessments (CAAs), and the RAI Utilization Guidelines.

The RAI process consists of three core components: The Minimum Data Set (MDS) as the assessment tool, the Care Area Assessment (CAA) process to further investigate triggered areas, and the RAI Utilization Guidelines which provide instructions for using the instrument.

Question 127: What is the primary difference between NAD83 and NAD27 horizontal datums?

NAD83 is geocentric and based on the GRS80 ellipsoid, while NAD27 uses the Clarke 1866 ellipsoid (Correct answer)
NAD83 uses feet while NAD27 uses meters
NAD27 incorporates GPS data while NAD83 is purely ground-based
NAD83 applies only to Alaska while NAD27 applies to the contiguous US

Correct answer: NAD83 is geocentric and based on the GRS80 ellipsoid, while NAD27 uses the Clarke 1866 ellipsoid

NAD83 is a geocentric datum based on the GRS80 ellipsoid and was defined using satellite data, while NAD27 is based on the Clarke 1866 ellipsoid with its origin at Meades Ranch, Kansas.

Question 128: A surveyor notes that a physician wrote an order for 'aspirin as needed for pain' without specifying dose, route, or frequency. How should this finding be evaluated?

A deficiency because medication orders must include dose, route, frequency, and indication to be complete and safe (Correct answer)
Only a problem if the resident is harmed
Non-issue if the pharmacist fills it correctly
Acceptable because aspirin is an over-the-counter medication

Correct answer: A deficiency because medication orders must include dose, route, frequency, and indication to be complete and safe

Complete medication orders must specify the drug name, dose, route, frequency, and indication; incomplete orders create ambiguity that can lead to medication errors.

Question 129: Which of the following best defines 'integration' as a Quality of Life requirement for Medicaid LTSS enrollees?

Enrollees participate only in plan-sponsored group programs
Enrollees are integrated into a single care management system
Enrollees have access to the same community activities as individuals without disabilities (Correct answer)
Enrollees are grouped together in disability-specific facilities

Correct answer: Enrollees have access to the same community activities as individuals without disabilities

Integration means enrollees have the same opportunities to participate in community life as people without disabilities, not segregated programming.

Question 130: A facility develops a comprehensive care plan for a new resident within 48 hours of their admission. This plan includes measurable objectives, timeframes, and addresses all identified needs from the comprehensive assessment. In this scenario, the facility:

is required to get a physician to co-sign the plan within the first 24 hours.
is out of compliance for completing the comprehensive plan too soon.
must still create a separate baseline care plan.
has met the requirements for both the baseline and comprehensive care plan timelines. (Correct answer)

Correct answer: has met the requirements for both the baseline and comprehensive care plan timelines.

According to 42 CFR §483.21(a)(2), a facility may develop a comprehensive care plan in place of a baseline care plan if it is developed within 48 hours of admission and meets all the requirements of a comprehensive care plan. By doing so, they fulfill the initial planning requirement.

Question 131: A resident with dementia frequently wanders into other residents' rooms, causing distress to them. To manage this behavior, the facility staff requires the resident to remain in a Geri-chair at the nurses' station for three hours every morning. Which resident right is MOST directly violated by this intervention?

The right to be free from physical restraints. (Correct answer)
The right to participate in their own care planning.
The right to reasonable accommodation of needs.
The right to privacy and confidentiality.

Correct answer: The right to be free from physical restraints.

Using a Geri-chair to prevent a resident from moving freely constitutes a physical restraint, especially when used for discipline or convenience rather than for medical treatment. Federal regulations at 42 CFR §483.10(e)(1) explicitly state residents have the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience.

Question 132: 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
Spouses who are both residents of the same facility have the right to share a room if they choose (Correct answer)
Room assignments are solely based on clinical need and the facility's discretion

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 133: When a resident is unable to participate in care plan development due to cognitive impairment, who must the facility involve?

The facility administrator
The resident's legal representative or family member if no representative exists (Correct answer)
The State Ombudsman only
Only the interdisciplinary team members

Correct answer: The resident's legal representative or family member if no representative exists

Federal regulations require facilities to involve the resident's legal representative or, if none, a family member when the resident cannot participate.

Question 134: 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?

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

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 135: What documentation should an interviewer complete when physical environment standards cannot be fully met during a survey visit?

A replacement respondent request form to substitute a different household
A formal written complaint submitted to the facility or household where the interview occurred
A field note or case observation recording the specific conditions, what was done to mitigate them, and any perceived effect on the interview (Correct answer)
A supervisor approval form that must be signed before the data can be entered

Correct answer: A field note or case observation recording the specific conditions, what was done to mitigate them, and any perceived effect on the interview

Detailed field notes about suboptimal conditions give researchers the information they need to assess data quality and make informed decisions during analysis.

Question 136: A surveyor finds that a resident identified with intellectual disability has no specialized services documented in the record and no PASRR documentation at all. The best immediate surveyor action is to:

Review the admission record and request PASRR documentation from the facility and state agency (Correct answer)
Issue an immediate jeopardy citation and close the survey
Assume PASRR was waived by the attending physician
Interview the resident's family and conclude the survey

Correct answer: Review the admission record and request PASRR documentation from the facility and state agency

Surveyors should request PASRR documentation from the facility and coordinate with the state to determine whether the screening process was followed.

Question 137: 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:

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

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 138: During a survey exit conference, which information must the surveyor provide to the facility?

The identity of any resident who participated in confidential interviews
The exact civil monetary penalty amount to be assessed
A verbal summary of deficiencies found and the basis for each citation (Correct answer)
Written confirmation that no additional deficiencies will be added after exit

Correct answer: A verbal summary of deficiencies found and the basis for each citation

The exit conference must include a summary of deficiencies and the evidentiary basis, but penalty amounts and resident confidentiality are protected.

Question 139: Which of the following services, if required to meet a resident's needs, must be described in the comprehensive care plan?

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

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 140: Which of the following is NOT a permissible reason for an involuntary discharge or transfer under federal nursing home regulations?

The facility is closing
The resident's health has improved and nursing home care is no longer needed
The resident filed a complaint with the State Survey Agency (Correct answer)
The resident's presence endangers the health or safety of others

Correct answer: The resident filed a complaint with the State Survey Agency

Filing a complaint with a regulatory agency is protected activity; discharging a resident for this reason is retaliatory and prohibited.

Question 141: 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 142: 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 resident agreed with the goals in writing
Whether staff were educated on the care plan and whether the plan is accessible at point of care (Correct answer)
Whether the administrator signed off on the care plan

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

A major decline or improvement that will not return to baseline within 2 weeks (Correct answer)
Any new physician order
A change in roommate assignment
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 144: Is a surveying method where the size and shape of the earth are taken into account. Large expanses and long lines are ideal for this kind of survey, which is used to pinpoint the exact placement of fundamental points required to set up control for subsequent surveys.

plane surveying
geodetic surveying (Correct answer)
route survey
topographic survey

Correct answer: geodetic surveying

Geodetic surveying accounts for the true size and shape (curvature) of the Earth, making it ideal for large areas and long lines and for fixing precise control points for later work. Plane surveying ignores curvature, while route and topographic surveys are project-specific types that rely on control established by geodetic methods.

Question 145: Which action BEST demonstrates a facility's commitment to a 'just culture' approach in its infection prevention program?

Requiring staff to sign a behavior contract after any infection event
Disciplining every staff member observed not washing hands
Encouraging staff to report near-misses and infection events without fear of blame (Correct answer)
Publishing individual hand hygiene compliance rates publicly

Correct answer: Encouraging staff to report near-misses and infection events without fear of blame

A just culture promotes psychological safety so staff report issues, enabling the facility to identify systemic failures rather than blaming individuals.

Question 146: During a Quality of Life survey, a surveyor interviews enrollees. Which finding would be MOST concerning?

Enrollees say they selected their own personal care workers
Enrollees state they are told when they must shower and at what time (Correct answer)
Enrollees report they can choose when to wake up and go to sleep
Enrollees report they attend community events of their choosing

Correct answer: Enrollees state they are told when they must shower and at what time

Mandating specific times for personal hygiene without enrollee input removes autonomy over basic daily decisions, directly violating Quality of Life standards.

Question 147: 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 formulate an advance directive.
The right to be free from coercion, discrimination, and reprisal. (Correct answer)
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 148: A resident refuses a care plan goal. The facility's correct response is to:

Document the refusal and the risks explained, then respect the resident's right to refuse (Correct answer)
Remove the goal from the care plan without documentation
Override the refusal and implement the goal anyway
Discharge the resident for non-compliance

Correct answer: Document the refusal and the risks explained, then respect the resident's right to refuse

Residents have the right to refuse treatment; facilities must document informed refusal and any education provided about risks.

Question 149: A quarterly MDS assessment is required approximately every:

180 days
90 days (Correct answer)
30 days
60 days

Correct answer: 90 days

Quarterly MDS assessments must be completed no less frequently than every 92 days following the annual comprehensive assessment.

Question 150: A surveyor assesses a facility's sharps disposal practices. Which observation indicates FULL compliance?

Sharps containers are placed in a central hallway location only
Used syringes are placed in regular waste bins lined with red biohazard bags
Needles are recapped after use before disposal to prevent needlesticks
Sharps containers are located at the point of care and replaced when three-quarters full (Correct answer)

Correct answer: Sharps containers are located at the point of care and replaced when three-quarters full

Sharps containers must be at point of care for immediate disposal and replaced before reaching capacity to prevent overfilling and injury.

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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