SMQT Nursing and Physician Services 3 — Questions and Answers
Question 1: Under SMQT-tested standards, which professional is primarily responsible for coordinating overall nursing services and ensuring compliance with care policies in a SNF?
- Director of Nursing (DON) (Correct answer)
- Attending physician
- Medical director
- Charge nurse of each unit
Correct answer: Director of Nursing (DON)
The Director of Nursing is responsible for planning, organizing, and directing nursing services and ensuring they comply with professional nursing standards and facility policies.
Question 2: A resident refuses to see the facility's assigned physician and requests her own personal physician. Under SMQT standards, the facility must:
- Accommodate the request and ensure the personal physician meets facility participation requirements (Correct answer)
- Deny the request if the personal physician is not on the facility's approved list
- Transfer the resident if the personal physician cannot comply with visit frequency
- Document the refusal as a resident noncompliance event
Correct answer: Accommodate the request and ensure the personal physician meets facility participation requirements
Residents have the right to choose their own physician; the facility must accommodate this choice as long as the physician agrees to comply with applicable requirements.
Question 3: When reviewing medication administration records, a surveyor finds that a licensed practical nurse administered IV push medications in a state where LPNs are not authorized to do so. This is a deficiency in:
- Nursing services — practice beyond licensed scope (Correct answer)
- Physician services — inadequate delegation
- Pharmacy services — dispensing error
- Resident rights — lack of informed consent
Correct answer: Nursing services — practice beyond licensed scope
Nursing staff must practice within their state-authorized scope; an LPN performing IV push medications prohibited by state law constitutes a nursing services deficiency.
Question 4: A surveyor observes that nursing aides are performing wound care without documented nurse supervision and the wound care policy requires RN oversight. What is the most appropriate deficiency tag area?
- Nursing services — supervision of nurse aides (Correct answer)
- Resident assessment — care planning failure
- Physician services — order specificity
- Quality of care — pressure ulcer prevention
Correct answer: Nursing services — supervision of nurse aides
Facilities are required to ensure nurse aides perform tasks within facility policy under appropriate nursing supervision; unsupervised wound care by aides violates this standard.
Question 5: Which scenario demonstrates compliant physician delegation to a physician assistant in a nursing facility under federal regulations?
- PA performs required interval visits with written physician collaboration agreement per state law (Correct answer)
- PA signs all physician orders without any documented physician review
- PA replaces physician entirely for all medical services for 90 days
- PA performs visits but the supervising physician is located in a different state
Correct answer: PA performs required interval visits with written physician collaboration agreement per state law
PAs may perform required physician functions when state law permits and a written collaborative agreement with the supervising physician is in place.
Question 6: A nursing facility surveyor notes that the facility's nursing care plan does not reflect the physician's current orders for wound treatment. This gap most directly represents a deficiency in:
- Comprehensive care planning — failure to integrate physician orders (Correct answer)
- Physician services — inadequate order documentation
- Medication management — treatment order accuracy
- Staffing — nurse failure to read orders
Correct answer: Comprehensive care planning — failure to integrate physician orders
Care plans must be consistent with current physician orders; a discrepancy indicates a failure in comprehensive care planning and interdisciplinary coordination.
Question 7: Under 42 CFR §483.70, which of the following is the medical director's primary responsibility in a nursing facility?
- Coordinating medical care and serving as liaison between physician staff and administration (Correct answer)
- Performing all resident physician visits when attending physicians are unavailable
- Approving all medication orders before they are implemented
- Supervising the Director of Nursing on clinical decisions
Correct answer: Coordinating medical care and serving as liaison between physician staff and administration
The medical director coordinates the medical care of all residents and serves as the liaison between the medical staff and the administration to ensure regulatory compliance.
SMQT Nursing and Physician Services 3
Under SMQT-tested standards, which professional is primarily responsible for coordinating overall nursing services and ensuring compliance with care policies in a SNF?