SMQT Dietary and Nutrition Services 2 — Questions and Answers
Question 1: 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?
- 2 meals plus snacks
- 3 meals plus snacks as needed (Correct answer)
- 3 meals at set times only
- 4 meals with no snacks required
Correct answer: 3 meals plus snacks as needed
CMS requires at least three meals per day plus snacks between meals and at bedtime as needed to meet residents' nutritional needs.
Question 2: A surveyor observes that a resident on a sodium-restricted diet is consistently receiving meals that do not comply with the ordered diet. Which F-tag is MOST directly implicated?
- F675 – Quality of Life
- F804 – Nutritive Value/Appear/Palatable/Prefer Temp (Correct answer)
- F812 – Food Procurement/Store/Prepare/Serve-Sanitary
- F809 – Frequency of Meals
Correct answer: F804 – Nutritive Value/Appear/Palatable/Prefer Temp
F804 addresses the requirement that food must be prepared in a form designed to meet individual needs, including therapeutic diet orders.
Question 3: When surveying a skilled nursing facility, a surveyor notices a resident's weight has dropped 8% over 30 days. Under MDS coding rules, this weight loss is classified as:
- Significant weight loss (Correct answer)
- Severe weight loss
- Moderate weight loss
- Clinically insignificant weight loss
Correct answer: Significant weight loss
A weight loss of 5% or more over 30 days meets the MDS definition of significant weight loss, triggering further assessment.
Question 4: A dietitian determines that a resident requires a mechanically altered diet due to dysphagia. The MOST appropriate texture level descriptor consistent with IDDSI framework for a resident who can manage soft, tender pieces is:
- Minced and Moist (Level 5) (Correct answer)
- Pureed (Level 4)
- Liquidized (Level 3)
- Regular (Level 7)
Correct answer: Minced and Moist (Level 5)
IDDSI Level 5 (Minced and Moist) is appropriate for residents who can manage small, soft, moist pieces but have mild chewing or swallowing difficulty.
Question 5: During a dietary observation, a surveyor finds food stored at 48°F in the walk-in refrigerator. The required maximum safe refrigerator temperature for potentially hazardous foods under federal food safety standards is:
- 45°F
- 41°F (Correct answer)
- 50°F
- 38°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 6: 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:
- Enforce the diet as ordered by the physician
- Document the refusal and provide the resident's food preferences while informing the physician (Correct answer)
- Transfer the resident to acute care
- Withhold meals until the resident agrees to the therapeutic diet
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 7: A certified dietary manager (CDM) is overseeing dietary operations in a SNF without a consultant dietitian on site. Under CMS regulations, which staffing arrangement is minimally acceptable?
- A CDM alone can fulfill all dietitian functions permanently
- A CDM may manage day-to-day operations if a qualified dietitian consults on a regularly scheduled basis (Correct answer)
- Any licensed nurse can substitute for a dietitian in dietary oversight
- A food service manager with 5 years experience may replace a dietitian
Correct answer: A CDM may manage day-to-day operations if a qualified dietitian consults on a regularly scheduled basis
CMS allows a CDM to manage daily dietary services provided that a qualified dietitian provides regularly scheduled consultation to ensure clinical nutrition needs are met.
SMQT Dietary and Nutrition Services 2
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?