SMQT Nursing and Physician Services 4

Question 1

A surveyor discovers that a facility allows nursing staff to take verbal orders from family members claiming to relay physician instructions. This practice violates which standard?

Accepted Answer

Physician orders must be received directly from the authorized practitioner, not through intermediaries

Answer

Verbal and telephone orders must be received directly from a licensed practitioner; relay through family members is not a valid order mechanism and creates serious patient safety risks.

Question 2

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?

Accepted Answer

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

Answer

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 3

A facility's staffing schedule shows that an RN is on duty for only one 8-hour shift per day, with LPNs covering the remaining 16 hours. This arrangement is:

Accepted Answer

Non-compliant — an RN must be on duty 24 hours per day, 7 days per week

Answer

42 CFR §483.35 requires SNFs to have a registered nurse on duty 24 hours a day, 7 days a week, with a limited exception only for facilities with a waiver.

Question 4

Under SMQT standards, when a physician determines that a required interval visit is medically unnecessary for a stable resident, what documentation is required?

Accepted Answer

The physician must document in the medical record that the visit was not medically necessary

Answer

Federal regulations allow a physician to skip a required interval visit for a stable resident, but the decision and rationale must be documented in the medical record.

Question 5

A surveyor interviews a resident who states she has not seen a doctor in four months. The medical record shows the last documented physician visit was 62 days ago. What should the surveyor do?

Accepted Answer

Reconcile the record with the resident's account and investigate whether documentation is missing or the visit did not occur

Answer

Surveyors must triangulate information from interviews, observations, and records; a discrepancy warrants further investigation rather than immediate citation or dismissal.

SMQT - Surveyor Minimum Qualifications Test Practice Test

SMQT - Surveyor Minimum Qualifications Test Practice Test

SMQT Nursing and Physician Services 4