Comprehensive Care Plan Process Flashcards
7 cards from real SMQT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Comprehensive Care Plan Process flashcards as text
Under federal regulations, how frequently must a nursing facility review and revise a resident's comprehensive care plan?
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.
Which interdisciplinary team member is primarily responsible for coordinating the comprehensive care plan meeting?
Answer: The Registered Nurse or designated care coordinator
A registered nurse or designated care coordinator typically organizes and leads the interdisciplinary care plan conference.
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:
Answer: Care plans require measurable goals with corresponding interventions
Regulations require care plans to include measurable objectives and specific interventions to address identified problems.
When a resident is unable to participate in care plan development due to cognitive impairment, who must the facility involve?
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.
A resident refuses a care plan goal. The facility's correct response is to:
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.
Which of the following best describes a 'significant change in condition' that would trigger an unscheduled care plan revision?
Answer: A documented decline in two or more ADLs that is not expected to resolve
A significant change requiring MDS reassessment—such as decline in multiple ADLs—also triggers a comprehensive care plan update.
Under OBRA regulations, within how many days of admission must a comprehensive care plan be completed for a long-term care resident?
Answer: 21 days
OBRA '87 requires a comprehensive care plan to be developed within 21 days of admission to a skilled nursing facility.
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- qsep.cms.gov — Test delivery, exam format, retake policy, score release, test dates, time limit, eligibility · verified Oct 2026