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232 Cards in this Set

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Abuse

Willful intent to cause harm. Abuse may be resident to resident or staff to resident harm.

Activities

Refer to any endeavor other than routine activities of daily living in which a resident participates that is intended to enhance his or her sense of well-being and to promote or enhance physical cognitive and emotional health. These include but are not limited to activities that promote self-esteem pleasure comfort education creativity success and independence.

Activities of daily living ADLs

Individual cell performance skills needed in everyday life such as ambulation locomotion eating toileting grooming personal hygiene and bathing.

Activity therapist

An allied health professional trained to develop and provide leisure time activities for facility residents

Advance directive

Written instructions from residence about the management and provision of care if they become incapacitated

Living Will, durable power of attorney, DNR

Adverse drug reaction ADR

Any unintended response to a drug which is injurious or harmful to health and which occurs at normal doses.

Ambulatory

Able to walk with or without difficulty or help

Annual assessment

An annual assessment of a resident's physical, mental, emotional, cognitive, and functional status.

Aspiration

The inhaling of foreign objects such as food or beverages if swallowed incorrectly into the lungs, results in introduction of bacteria from the mouth and stomach into the lungs which can lead to pulmonary bacterial infections known as aspiration pneumonia.

Behavioral intervention

Non drug interventions used to change the residents behavior or environment to lesson or accommodate the residents behavioral symptoms.

Care plan

A plan designed to meet all of a residence identified physical, mental, emotional, cognitive, and functional needs. The care plan is generally the result of assessment and collaboration by an interdisciplinary team of providers staff.

Case mix

A system that uses resident attributes, i.e. functional status in a ADL or cognitive ability, to classify residents for purposes such as reimbursement.

Centers for Medicare and Medicaid Services - CMS

Federal agency responsible for administering the federal Medicare and Medicaid programs. CMS headquarters is located in Baltimore.

Chemical restraint

A psychoactive drug used by a facility for discipline or convenience and not for medical treatment.

Chronic

Continuing over a long period of time or recurring frequently. Chronic conditions often begin inconspicuously and symptoms are less pronounced than in acute conditions.

Chronic care

Care for residents who enter a nursing facility typically because they have chronic illnesses that require more assistance than they have available in their own home. These residents tend to remain in the facility for several months to years.

Consultant pharmacist

Pharmacist who is contracted by the nursing home to do drug regimen reviews and provide other services.

Continence

The ability to self-regulate bladder and bowel elimination.

Controlled substance

A drug, substance or immediate precursor included in schedules I to V of the Controlled Substance Act.

Morphine, acetaminophen with codeine, oxycodone.

Dentition

To make up of a set of teeth including their kind, number, arrangement and usability.

Dietary history

A review of a resident food intake patterns, including any food preferences, chewing and swallowing problems, or difficulties with self feeding that might affect overall food intake.

Drug irregularity

A drug that is given without a medical reason, and an excessive or inadequate dose or duration of therapy, where side effects indicate that a dose modification or drug discontinuation is indicated, or inadequate monitoring for effect or manufacturer's recommendations for laboratory monitoring. This therapy results and potential negative outcome or is not achieving the stated objectives of the prescriber. The consulting pharmacist should address this potential drug therapy problem at the time of the drug regimen review.

Drug regimen review

The review of drugs being used by a resident to determine effect and potential for harmful effects.

Drug utilization review

The study of drug use patterns in a facility.

Enforcement grid

A table developed by the Center for Medicare and Medicaid Services that define severity and scope of federal deficiencies and indicates whether plans of correction and remedies are necessary.

Energy metabolism

The process in the body of breaking down calories consumed into usable energy to allow the body to perform normal body functions.

Extended Survey

A federal survey conducted within 14 days of a finding of substandard care during a standard federal survey.

Extrapyramidal symptoms

Abnormal movements of the mouth or tongue, pill rolling, tremors, rigid movements, mask like face, constant movement of legs or body, tics, blinking, pacing, eyes rolled up, drooling.

Gait

How a person walks

Guardian

Legal representative, appointed by a court, to make decisions for a person not competent to make their own decisions. Generally resident guardians have all of the legal rights normally granted to competent residents.

Harm

Negative effect that has occurred to a resident, infringement of a resident rights, for compromising of a resident ability to meet their highest practical level of physical, mental, or psychosocial well-being.

Hospice care

Supportive care provided to terminally ill patients and their families in the final six months, per Medicare, of a patient's life. This care is managed and coordinated by a certified Medicare hospice provider.

Hypnotic medication

A psychoactive medication given to sedate or calm.

Seroquel, Sonata, restoril, ambien.

Immediate jeopardy

A situation in which a provider's non-compliance with one or more regulations has caused or is likely to cause serious injury, harm, impairment, or death to a resident.

Incidence

A type of CHSRA QI that provides a description of what has taken place with a resident over the course of the last 2 MDS or oasis assessments.

Incontinence

Lacking voluntary control over the bladder or bowel. In most people incontinence can be treated and controlled, if not cured. Specific changes in body function, often resulting from disease or the use of medications, are the cause of incontinence.

Individual program plan

A written statement of the services to be provided, as developed by an interdisciplinary team, and based on a comprehensive functional assessment of an individual's active treatment needs.

Informed consent

The person giving consent receives information necessary to make a health care decision, including information about the benefits, reasonable risks, alternatives, the right to refuse, and consequences of any treatment or service.

Initial survey

And on-site federal survey to determine whether provider meets the requirements to begin participating in the Medicare and Medicaid programs.

Instrumental activities of daily living

Activities that include meal preparation, housework, managing finances or medications, telephone use, shopping, and transportation, how one moves up and down stairs, and in and out of vehicles.

Interdisciplinary team

A facility team which allows involvement of multiple medical disciplines and providing patient care, can consist of all or some of the following professionals: physician, nurse, social worker, case manager, dietician, therapist, pharmacist, etc.

Medicaid

East a program that provides medical services to clients of the state Public Assistance Program and have the state's option other needy individuals as well as supplements hospital and nursing facility services that are mandated under Medicaid. States may decide on the amount, duration, and scope of additional services. Generally, the only types of institutions participating solely and Medicaid are nursing facilities and intermediate care facilities for the mentally handicapped.

Medical nutrition therapy

A diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, decrease or increase specific nutrients in the diet.

Therapeutic diet

Medicare

A Federal Insurance Program providing a wide range of benefits for specific periods of time through providers and suppliers participating in the program. Providers in Medicare are patient care institutions such as hospitals, hospices, nursing homes, and home health agencies. Benefits are payable for most people over the age of 65, Social Security beneficiaries under the age of 65 entitled to disability benefits, and individuals needing renal dialysis or renal transplantation. Payment for services is made by the federal government through designated fiscal intermediaries and carriers to the providers and suppliers.

Minimum data set - MDS

A federally mandated resident assessment instrument used to assess resident physical, mental, emotional, cognitive, and functional limitations and strengths. The MDS must be administered to all residents in Medicare or Medicaid certified facilities at time of admission, annually, quarterly, and when a significant change in a resident's condition occurs.

Misappropriation

The deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a residents belongings or money without the residents consent.

Neglect

Failure to provide goods and services to prevent resident harm.

Nosocomial infection in the long term care facility

An infection that develops after admission to the long term care facility. Infections that are incubating at the time of admission, or develop within 48 to 72 hours of admission, usually our community acquired or hospital associated if the person was transferred from the hospital.

Nurse practitioner

A registered nurse who meets additional state requirements to meet this designation. In some states, nurse practitioners may act as physician extenders to conduct certain activities such as ordering tests and medications.

Nursing Home administrator

The person in charge to operate a nursing home and licensed by the state. As the nursing home evolve the title of the person was changed from operator to nursing home administrator. Since then that term nursing home is change to nursing facility. If you stage change nursing home administrator to nursing facility administrator. However, that term nursing facility has not become popular. Predominantly they are called nursing homes, so the title nursing home administrator is likely to remain in vogue.

Nursing Home quality improvement initiatives

A program of the Centers for Medicare and Medicaid Services and US Department of Health and Human Services compiles information about nursing home residents on 8 conditions or situations or conditions called quality measures and makes the information available to consumers.

Occupational therapist

A person licensed, certified, or registered under state statutes to perform as an occupational therapist. Generally these individuals are certified by the American Occupational Therapy Association.

Occupational therapy

Specializes in the adaptive use of the upper extremities for performing various tasks, evaluating and treating functional impairment in the activities of daily living. Occupational therapist also play a vital role in evaluating the independent living environment when the patient is scheduled for discharge to home.

Ombudsman

Paid or voluntary staff that investigate nursing home complaints from residents and their families and act as resident advocates addressing concerns of nursing home residents. Many Ombudsman programs are associated with state departments or boards of aging.

Omnibus Budget Reconciliation Act of 1987

A.k.a. OBRA; changes to the federal Social Security Act that significantly changed how nursing homes and home health agencies are regulated for Medicare and Medicaid certification.

One-to-one Programming

Refers to programming provided to residents who will not, or cannot, effectively plan their own activity pursuits, or residents needing specialized or extended programs to enhance their overall daily routine and activity pursuit needs.

Online survey certification and reporting

Also known as OSCAR;CMS database that includes Medicare and Medicaid certified facility demographic information, results of on site surveys, and aggregate nursing home resident characteristics for comparison with state and national peer information.

Palliative care

Management and support provided for the reduction or basement of pain, for other physical symptoms and for psycho social and spiritual needs of individuals with terminal illness and includes physician services, skilled nursing care, medical services, social services, services of volunteers and bereavement services, but does not mean treatment provided to cure a medical condition or disease or to artificially prolong life.

Percentile rank

For the CHSRA Qi a means of ranking providers based on how they compare with each other on each separate Qi. To hire a providers percentile ranking, the more apt the provider is to have a care concern.

Person appropriate activities

Refers to the idea that each resident has a personal identity and history that involves more than just his or her medical illnesses or functional impairment.

Physical restraint

Devices that prevent or restrict resident movement. A device or manual method that works to treat a medical symptom that is attached to or adjacent to the individual's body so that freedom of movement or normal access to one's body is restricted.

Physical therapist

A person licensed, certified, or registered by state statute to perform as a physical therapist. Generally these individuals are certified by the American Physical Therapy Association.

Physical therapy

Focuses on evaluating and treating musculoskeletal disorders, geared toward improving ambulation, joint mobility, and balance, strength training, sitting and using artificial limbs, training to use canes and walkers.

Physician assistant

A person licensed or certified by state statute to perform as a physician assistant.

Plan of correction

A provider's plan for how and when it will correct federal deficiencies and or state violations

Post acute care

Care for residents who are admitted to a facility following an acute care hospital is a shin. Care may involve high-intensity rehabilitation or clinically complex care. Most post-acute stays or for less than 30 days. Some post-acute stays lead to long-term admissions for chronic care.

Post survey revisit

And onsite provider visit intended to verify correction of deficiencies and or violations cited during a survey.

Pre-admission screening annual resident review report (PASSAR)

Federally required screening of all nursing home residents, prior to admission, to determine if the individual residents are mentally ill or mentally handicapped.

Pressure sore or pressure ulcer

An inflamed lesion of the skin or internal mucous tissue caused by pressure or friction. Pressure sores are classified in stages, stages 1 through 4 for increasing severity.

Prevalence

A type of Qi or QM that provides a description of a resident or patient at a point.

Prior assessment

The assessment that occurs in the most recent four months, 46 - 165 days, preceding the target assessment.

Program of activities

Includes a combination of large and small group, 121, and self-directed activities, and a system that supports the development, implementation, and evaluation of the activities provided to the residents in the facilities.

Provider initiative project (PIP)

High quality indicator information system for long term care developed by the Center for Health Systems Research and Analysis CHSRA at the University of wisconsin-madison that utilizes MBS assessment data.

Psychoactive medication

Medications used to change, modify, or alter an individual's behavior or mood. This general term includes anti anxiety, antidepressant, antipsychotic, and hypnotic medications.

Xanax, Haldol

Psychotropic medications

Psychoactive medications used to change, modify, or alter an individual's behavior or mode. This general term includes anti-anxiety, and he depressant, antipsychotic, and hypnotic medications.

PUID (personal user identification)

The personal user ID is an individual log on that is unique to each staff member who uses the ePIP system. New IDs can be requested at any time by contacting the ePIP help desk.

QI domain

For the CHSRA QI SO the broad areas of care that represent the common conditions and important aspects of care in life to nursing home residents. Each domain is represented by one or more QIs.

Quality assurance

A provider program to monitor and study the quality of the services it delivers, and to make recommendations for improvement. A designated quality assurance committee usually coordinate this activity.

Quality indicators (QIs)

CHSRAs indicators of provider level and resident level status to ride from MDS or oasis information. The QIS are pointers or signpost of potential resident and or provider care problems. Quality indicators are used by surveyors to help structure that survey process and can be used by providers to help monitor and improve their own performance.

Quality measures

Publicly reported information made available by CMS to help consumers assess the quality of nursing home care. There are two categories of quality measures. Number one, conditions relevant primarily to long-term residents including decline in late loss ADLs, pressure sores, residence with pain, physical restraints, and prevalence of infections. Number 2, short stay residents with pain an improvement in walking. Many of the quality measures are based on in virtually identical to quality indicators.

Quality of care

General area of the federal nursing home requirements that addresses specific areas.

Quality of life

General area of the federal nursing home regulations that addresses resident life issues such as dignity, participation in activities, social services, accommodation of needs, and the facilities environment such as lighting, sound, temperature and home like environment.

Quarterly assessment

MDS assessments required each quarter for all residents in Medicare and or Medicaid facilities.

Range of motion

The extent or magnitude of a residence joint movement.

Recreational therapist

A person certified by a recognized certifying organization to perform as a recreational therapist

Registered dietitian

The health professional designated to oversee food and nutrition services and acute and long-term care settings by both the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of health care organizations; this professional has received a degree in Nutrition Science, completed a 1,000 hour dietetic internship, and passed a comprehensive national registration exam with a minimum of 15 continuing education hours that must be obtained and approved by the Commission on dietetics registration for the registered dietitian credentials to be maintained.

Regulations

Federal requirement promulgated to hash out the statutory requirements in the Social Security Act

Resident assessment instrument

A tool to help facilities identify residents needs and strengths and develop an appropriate care plan. The federal Rai system includes the MDS, raps, and utilization guidelines.

Resident assessment protocols - RAPS

18 problem-oriented guides for care planning with trigger conditions to signal the need for additional assessment and review.

Activities RAP, mood state RAP, pressure ulcer RAP

Resident centered care

Practices that encourage residents to be involved in making decisions about their care and daily activities. Examples of residents enter dietary functions include cooked-to-order eating schedules, resident involved menu planning, and buffet style or family dining meal service.

Resource utilization groups - RUGS

A collection of nursing facility resident classification systems used in a variety of case-mix indexed reimbursement systems. Using assessment tools like the MDS 2.0, these systems group residents I expected level of resource utilization, usually based upon staff time measurements per resident per day. Relative resource utilization is reflected in a case mix index, CMI, value assigned to each rug cell.

Scope

The extent or magnitude of deficient facility practice on Resident outcome. There are three levels of scope as described in the federal enforcement grid.

Sentinel health events

Significant conditions or events that exist for only a single case or a few cases. For the CHSRA Qi, they may represent a significant problem that needs to be investigated.

Fecal impaction, dehydration, pressure ulcers

Severity

The effect or seriousness of deficient facility practice on Resident outcome. There are four levels of severity as described in the federal enforcement grid.

Shelf stable food

Preserved, often canned or boxed, food which is able to be stored at room temperature for long periods and made ready for service in an emergency situation without the use of electricity.

Short term stay

Admission and discharge of a nursing home resident that occurs in less than 14 days.

Side effect

Undesirable effects of a medication that causes minimal discomfort in some people.

Significant change

A major decline or improvement in a residence status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one area of a resident's health status and requires interdisciplinary review or revision of the care plan, or both.

Significant change in condition

A substantial modification and a resident's physical, mental, emotional, cognitive, or functional status that requires a new assessment using the MDS instrument, and also generally requires notification of the residence attending physician, family, or guardian.

Significant medication error

Medication error that causes a resident discomfort and/or jeopardizes his or her health and safety

Significant weight loss

The threshold used to determine when intervention and documentation is required to prevent undernutrition from excessive weight loss in the long term care setting. Significant weight loss is 5% in 30 days, 7.5% in 90 days and 10% in 180 days.

Skilled nursing facility

A nursing home that meets the requirements for Medicare certification as defined in 1819 A of the federal Social Security Act. Also the term used by most states to define the type of nursing home that is licensed to provide the highest level of care.

Social Security Act

Federal statutory law that includes the requirements for participation in the Medicare and Medicaid programs

Speech pathologist

A person licensed, certified, or registered by state statute to perform as a speech pathologist

Speech therapist

A person licensed, certified, or registered by state statute to perform as a speech therapist.

Speech language pathology

Encompasses evaluation and treatment of speech, language, and cognitive disorders. Treat several kinds of disorders such as aphasia, dysarthria, and dysphasia.

Standard survey

An on-site federal survey of nursing homes conducted every 9 to 15 months to determine compliance with federal regulations for Medicare and or Medicaid.

Statement of deficiency

A written summary of non-compliance with regulations foundering a federal provider survey or complaint investigation. Statements of deficiency are written on a CMS 2567 form.

Subacute

Type of nursing home care that is generally considered above skilled nursing but below acute hospital care.

Substandard care

Substandard quality of care is any deficiency in 42 CFR 483.13 resident behavior and facility practice, 42 CFR 483.15 quality of life 442 CFR 483.25 quality of care that constitutes immediate jeopardy to resident health or safety, or a pattern of or widespread actual harm that is not immediate jeopardy, or a widespread potential for more than minimal harm that is not immediate jeopardy, with no actual harm. On the federal enforcement grid, substandard care equates to boxes f, h, i, J, K & L, and results in imposition of penalties.

Substantial compliance

Minor deficiencies or violations, but a facility generally meets the intent of federal or state regulations. On the federal law enforcement good, substantial compliance is equated to findings in boxes A through C.

Target assessment

The most recent full or quarterly assessment that is available for the time in which the QM score is calculated.

Terminal care

Care provided to a dying resident that may or may not include hospice care.

Texture modification

Changing that consistency of food offered to a president to help accommodate difficulties in chewing or swallowing, textures can include chopped food, ground food, and pureed food.

Therapeutic diet

He diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, disease, or increased specific nutrients in the diet.

Medical nutrition therapy

Threshold

A set point for each CHSRA Qi at which the likelihood of a problem is sufficient to warrant further investigation. There may also be a concern below the threshold especially if the percentile rank is close to the threshold. Generally, the threshold point is set at the 90th percentile.

Unnecessary drug

Any of the following: drugs that are given without a medical reason, drug given and excessive dose, drug given for an excessive amount of time, tried without adequate monitoring, drug given with side effects and or adverse drug reactions indicate the drug should be reduced or discontinued.

Universal precautions

Measures taken to prevent transmission of infection from contact with blood or other body fluids or materials having blood or other body fluids on them, as recommended by the US Public Health Services Centers for Disease Control and adopted by the US Occupational Safety and Health Administration OSHA as CFR 1910. 1030.

Variance

The granting of an alternate requirement in place of a federal or state regulation.

Waiver

Violation

A written summary of non-compliance with regulations found during a state provider survey or complaint investigation. The written document is generally called a notice of violation.

Waiver

The granting of an exemption from federal or state regulation.

Written policies and procedures are used by the facility for all of the following EXCEPT:


A. To communicate what management expects in any situation


B. To prepare staff for dealing with emergency situations


C. To establish the management style for operating the facility


D. To set guidelines for staff to follow and delivery of care

C. Management style varies from administrator to administrator. Policies and procedures are the steps required to operate a facility and to ensure proper care for all residents.

When admitted to the nursing home which of the following is not required to be given to the resident:


A. The residents rights and rules and regulations governing resident conduct and responsibilities during the stay in the facility


B. Services to be provided and their associated costs


C. The federal standards and state licensing rules for nursing facilities


D. Information regarding an advance directive

C. Facilities are not required to give the resident or the designated family member appointed responsibility a copy of the federal certification standards or the state rules for nursing facilities.

In the case of non Medicare Part A residence the initial resident assessment must be completed within


A. 10 days of admission


B. 14 days of admission


C. The first week of admission


D. Prior to formally admitting the resident

B. 14 days; This is the time limit set by CMS for completing the initial evaluation

According to the federal certifications standards the QA committee is required to meet:


A. When a problem arises that requires immediate attention


B. At least twice a year


C. At least quarterly


D. When directed by the medical director

C. CMS requires the QA community to meet quarterly

A resident is admitted to a nursing home that has been certified as a Medicare skilled nursing facility only. Which of the following is not required to be adhered to by the facility:


A. State Medicaid standards for payment


B. Skilled nursing facility regulations


C. State licensing regulations


D. Office of civil rights laws

A. Medicaid standards of payment are not applicable in this case

Unless a waiver has been secured a registered nurse is required to be in the facility:


A. At least 8 hours within every 24 hour period


B. At least 8 consecutive hours a day, 7 days a week


C. At least 8 consecutive hours Monday through Friday


D. There is no minimum number of hours required

B. Except when waived, the facility must use the services of a registered nurse for at least eight consecutive hours a day 7 days a week.

Restorative care must be provided:


A. Only with the order of the facilities physical therapist


B. By specialized qualified staff for which the facility has contracted services


C. Only of the resident can't provide his or her own care


D. The nursing staff based on a comprehensive assessment

D. The following statements are contained in task 10.2. When nursing is developing the residence restorative plan they must assess the resident's current abilities as well as the potential of the resident. Residents who have limited mobility will benefit from active and or passive range of motion programs provided by nursing staff. This would support that nursing service is primarily responsible for providing restorative care.

The facility staff will determine what the needs of the resident are based on:


A. Quality indicator reports


B. Family interviews


C. The MDS assessments


D. Quality measures

C. MDS assessments; The facilities staff must conduct this assessment within 14 days of admission and once every 3 months to determine each residents needs.

Physician visits are required:


A. Monthly after the initial required visits


B. Quarterly after the initial required visits


C. Every 60 days after the initial required visits


D. Twice a year after the initial required visits

C. Every 30 days for the first 90 days, then at least once every 60 days thereafter.

Which one below is an exception to one of facility may release resident identifiable information under the HIPAA privacy standard without the resident's permission:


A. For a research study conducted by CMS


B. When any immediate family member request it


C. To consumer groups


D. When a resident is transferred to another health care institution

D. Resident transfer and an official court order are the only reasons that a residents information can be released without his or her permission

Standard precautions, previously referred to as universal precautions how are to be used when providing personal care to:


A. All residents


B. Residents with AIDS


C. Residents with hepatitis


D. Residence with tuberculosis

A. All residents; each person providing personal care to a resident must proceed on the assumption that all residents blood and body fluids are infectious.

All of the following are barriers regarding the recognition of chronic pain except for:


A. Cognitive impairment and communication barriers, language or speech, gender of residence ability to report pain or respond to caregivers questions regarding pain


B. Staff who are utilizing valid tools to screen for pain


C. Elderly may not show verbal or nonverbal symptoms of pain


D. Staff may not have knowledge of or be skilled in assessing pain

B. The instrument the staff utilizes to screen for pain does not create any type of barrier for them to determine if the resident is experiencing pain. All of the others are related to the ability of the resident to express pain or the staff to evaluate the presence of pain.

Which of the following does not support resident centered care concepts?


A. Upon admission the resident indicates a preference to bathe at night, the facility policy requires all has to be given on the day shift.


B. Breakfast is served from 6:30 a.m. to 8 a.m., the resident chooses to sleep until 9 a.m. so the nursing staff make sure cereal and milk are available at 9.


C. Upon admission the resident was allowed to bring his personal recliner to the facility to furnish his room.


D. Prior to living in the nursing facility the resident enjoyed fishing, the activities staff arrange for the resident to attend the annual fishing rodeo located 30 miles from the facility.

A. The resident has the right to choose what time his or her preference for taking a bath is.

Facilities are expected to provide a pleasant dining experience for all residents. This includes all except:


A. Providing well lit, well ventilated, dining room


B. Providing adequate space and seating accommodations


C. Maintaining a level of dignity when serving all residents


D. Serving residents without attempting to honor residents food preferences

D. Resident food preferences should always be honored within limitation of the diet orders

Which one of the following is not a correct policy for dietary services?


A. Receiving of food or facility use must be from approved sources


B. Storage of food brought in by staff must be stored separately from facility food


C. Facilities are required to provide a therapeutic diet, prescribed by the dietary consultant when a nutrition problem exists


D. A specific food temperature level is required at the time of serving

C. Facilities are required to provide a therapeutic diet prescribed by the attending physician when a nutrition problem exists

One specified reason for a significant change comprehensive reassessment is an unplanned weight loss of either_________% over 30 days or _________% over 180 days?


A. 5%, 7%


B. 7%, 10%


C. 5%, 10%


D. 10%, 30%

C. Significant weight loss in the long term care setting is defined as 5% weight loss in 30 days, 7.5% weight loss in 90 days, and 10% weight loss in 180 days.

Which one of the following statements is true for the medical director?


A. May also serve as an attending physician


B. Must be a member of the facility's quality assessment committee


C. Must be seen by the resident at least every 30 days after the initial required visits


D. Must personally approve each order for each individual to be admitted to the facility

A. The medical director may also serve as an attending physician within the facility, but the roles and functions of each must be kept separate

Which of the following statements is true regarding a facility providing medically related social services in the facility?


A. A facility must have a full time qualified social worker on staff for each work shift except weekends


B. A facilities qualified social worker must have a bachelor's degree in social work and one year of supervised experience in a healthcare setting working with individuals


C. A facility must have one qualified social worker for each 75 residents


D. A facilities qualified social workers bachelor's degree can be in a human services field or in another degree with one year of supervised social work experience in a healthcare setting working directly with individuals

D. The qualified social worker does not have to have a bachelor's degree in social work. The person can have a bachelor's degree in a human service field or a bachelor's degree with one year of supervised social work experience in a healthcare setting working with people.

Nurse aides must have a minimum of _____ hours of inservice training annually.


A. 6


B.10


C.12


D.16

C. Nurse aids are required to have it at least 12 hours of in-service training each year. Individual states may require more or require specific content with the training hours.

Which one of the following statements is true?


A. Any employee may serve as a feeding assistant when the need arises


B. A family member must complete a state approved training course for feeding assistance before assisting with feeding his or her family member


C. Paid feeding assistants must successfully complete a state approved training course


D. A family member is not allowed to feed his or her relative

C. A paid employee or paid feeding assistant may not serve as a feeding assistant without completing a state-approved training course for feeding assistance, but a family member is not required to complete the course before feeding his or her family member

Which of the following changes in the dietary department would most closely reflect the principles behind culture change?


A. Providing set meal service times with little flexibility to maintain a daily routine for the residents


B. Liberalizing therapeutic diets to provide more food choices to residents


C. Increasing the number of pureed or soft day orders to make feeding easier for the staff


D. Structuring mealtimes to the benefit of staff schedules

B. Facilities are encouraged to allow residents to make choices about aspects in life that are significant to them. Liberalizing diets is one way to offer such choices

Which one of the following is not a function of the activities director within a facility?


A. To ensure that the culture, functional ability, cognitive level, and background of the individuals contribute to enhancing personal identity, self-esteem and dignity of the residents


B. Develops the restorative therapy program for each resident


C. He or she is a part of the comprehensive assessment team within the facility


D. May form small groups or clubs to include residents of like interests

B. The restorative therapy program is developed by the nursing staff

If a resident refuses to consume all of a meal initially given to him or her the nursing staff should:


A. Do nothing, it is the residents right to refuse meals


B. Document that the resident was being uncooperative for that particular meal


C. Offers suitable meal replacement or nutrition supplement to provide adequate calories


D. Force feed the resident the meal as served

C. If all foods refused or refuse that a given meal. The nursing staff should offer the resident a suitable meal replacement or nutritional supplement that complies with their diet order in an effort to provide caliries equivalent to the meal

Which one of the following statements is correct regarding activities provided through the activities department of a facility?


A. Spiritual activities are not permitted in a facility that receives federal dollars


B. Manicures and pedicures, hair styling, and makeovers may be considered part of the activities program


C. Trips to casinos and other gaming capabilities, museums, fishing events are not permitted because of the liability for facilities


D. Most activities which are scheduled by the activity director should be of a physical nature in order to help residents increase or maintain their mobility

B. These activities are defined as acceptable activities in the survey operations manual, tag F 248. There are no restrictions on spiritual activities or types of field trips. Activities should be developed to meet more than their physical needs.

Which one of the following statements is correct about nasal gastric tube feeding while in a facility?


A. An individual who needs to be fed may be given a nasogastric tube to make eating easier for the resident


B. The facility must ensure that the resident receives appropriate treatment to restore normal eating skills if possible


C. With the families permission the resident may be given a naso-gastric tube


D. The initial assessment demonstrates with the resident's clinical condition indicates he or she cannot eat by himself or herself.

D. If the comprehensive assessment of a resident's clinical condition demonstrates that use of a tube was unavoidable the facility must ensure that the resident receives the appropriate treatment to restore if possible normal eating skills.

According to the federal certification standards when a nourishing snack is provided at bedtime, up to ________ email apps between a substantial evening meal on breakfast the following day if a resident group agrees to this meal span.


A. 12 hours


B. 16 hours


C. 14 hours


D. 15 hours

B. When a nursing snack is provided at bedtime up to 16 hours may elapsed between a substantial evening meal and Breakfast the following day if a resident group agrees to this meal plan and a nursing snack is served.

____________ transfer to any endeavor in which a resident purchase a page that is intended to enhance his or her sense of well-being and to promote or enhance physical, effective, spiritual, cognitive, and emotional health.


A. Activities of daily living


B. Instrumental activities of daily living


C. Activities


D. Occupational therapies

C. This is the definition of activities in the survey operations manual under tag F248

How many hours a day must the facility provided resident with access to physician services or with transportation to a hospital emergency room?


A. 8 hours


B. 12 hours


C. 18 hours


D. 24 hours

D. The facility must provide or arrange for the provision of physician services 24 hours a day. Arranging for physician services may include ensuring transportation to a hospital emergency room or other medical facility if the facility is unable to provide emergency medical care at the facility.

In the event of an error in administration of medication which of the following should be notified first?


A. Report to the attending physician


B. Report the error to the director of nurses


C. Report to the administrator


D. Report to the family

A. When a medication error has occurred the residents condition at the time is the most important consideration. The resident must be assessed and the position must be immediately notified of the physical findings and the details of the medication error so the appropriate medical intervention can be initiated.

A valid court order directing that medical records be made available to a given third party, or revealed in a given circumstance, must be honored:


A. Only if the resident has raised the issue of his or her medical care and a lawsuit


B. But the residents consent is required if the third party is an insurance company


C. Only with the residents consent


D. The residents consent is not required

D. A resident's medical record must be kept confidential and free from any unauthorized disclosure without the residents consent except when release is required by law, transfer to another facility, or the resident request his or her chart.

Medications not given as intended by the prescriber, as required by the drug manufacturer, or according to acceptable professional standards is:


A. Polypharmacy


B. Drug regimen


C. Medication error


D. Drug therapy

C. Not administering a drug as required is a medication error. Polypharmacy is taking too many medications, drug regimen is the plan to be followed in giving drugs, and drug irregularity is giving a drug without medical reason.

Facility employees are allowed to serve as feeding assistance during meal time as long as they meet certain requirements. Which of the following statements is not true?


A. Feeding assistants must work under the supervision of a RN or LPN


B. Feeding assistance can only assist residents who have no difficulty swallowing


C. Feeding assistance must complete a state-approved training program


D. Feeding assistance can assist residents who are at risk for aspiration

D. Feeding assistants are not allowed to feed residents who have complicated feeding problems such as difficulty swallowing, aspiration risk, and feeding tubes.

With increased focus on resident centered care, resident quality of life, and culture change more attention is being given to the rights of the residents what do these policies and procedures ensure?

The resident has a right to a dignified existence, self-determination, and communication with an access to persons and services inside and outside the facility. The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States. The resident has the right to equal access to quality of care. They care must be identical for all residents regardless of their source of payment.

What is the patients off to termination Act passed in 1990

The patient self-determination Act requires all health care facilities to recognize a persons living will or power of attorney for health care decisions as their advance directives.

Specialty medical services

The facility is directly responsible for the dental care needs of its residents. Melody must ensure that a dentist is available for residents. If the comprehensive assessment indicates problems with vision and hearing the facility is also responsible for assisting the residents and their families in locating and utilizing available resources.

Physical activities

Activities that include active games such as ball bouncing, bowling, ring toss, bean bag toss, exercises, dancing.

Cognitive or educational activities

These activities are for intellectual stimulation which include problem-solving activities, board games, learning by reading, poetry, drama, puzzles, art.

Affective activities

These activities include the need to feel love of self and love of others, to feel secure, to feel accepted, to be recognized or enhance sensory stimulation.

Integration awareness

These activities are things that can build self-esteem such as delivering mail, folding laundry participating in resident Council

Clinical records must be retained for ________?

The period of time required by state law for 5 years from the date of discharge when there is no requirement in state law or for a minor 3 years after a resident reaches legal age under state law. CMS requires a minimum of 6 years.

At a minimum federal law specifies the nursing home must protect and promote the following rights of each resident:

Freedom from discrimination, respect, freedom from abuse and neglect, freedom from restraints, information on services and fees, medical care, the right to visitors, social services, leaving the nursing home, complaints, protection against unfair transfer or discharge, family members and legal guardians may meet with the families of other residents, the right to form resident groups.

Successful human resource management and body several key management functions:

Planning, organizing, staffing, leading, evaluating, and controlling

Planning (HR)

Planning pervades every activity within the facility. Planning is the central function of management. 8 types of plans that are used by most enterprises are: purpose or mission, goals of the organization, strategies, policies, procedures, rules, programs, and budgets.

Performance appraisal errors

The halo effect, leniency error, and the error of central tendency.

Halo effect

The halo effect occurs when a manager permits the presence or absence of one particular job behavior.

I.e. punctuality

Leniency error

The leniency error occurs when a manager, seeking to avoid conflict, consistently gives high ratings to all employees.



Opposite is strictness error; occurs when a manager rates everyone low.

Error of central tendency

This error occurs when a manager, seeking to avoid conflict, consistently gives moderate ratings regardless of performance.

Expectancy Theory

The belief that the level of motivation to perform is a mathematical function of the expectations individuals have about future outcomes multiplied by the value the employee places on these outcomes.

Federal mediation and conciliation service

The federal mediation and conciliation service is a federal agency making government facilities available for conciliation, mediation and voluntary arbitration of Labor disputes.

Flex time

Flex time is a program allowing employees to choose the hours they work so long as they put in the expected number of hours per time frame.

Flexible spending account

An optional benefit in which employees can set aside a designated amount of funds for future Medical Services. As medical services are incurred, the charges made against the account. The funds are usually a pre-tax withdrawal from the employees check. The optional benefit must be a careful calculation and is usually for persons that have consistent or relatively High medical expenses. There is an administrative fee from the processing agent and funds not used can't be carried over to the next year.

Global rating

A summary score based on the components of a performance appraisal

Goal setting

Setting of objectives to be achieved by an employee before the next performance appraisal

Grievance procedure

The established method, and outlined in the employee handbook, by which an employee can have any decision of a supervisor reviewed by higher-level management with the organization.

Halo effect

Air made by supervisors using rating scales in an employee evaluation with a value one particular type of job behavior and permit the presence or absence of that one trait the color several or most other trait ratings.

Health insurance

A fringe benefit available to many Nursing Facility employees. Typically the employees covered free or shares in the cost, and can obtain family coverage for an additional periodic payment.

Health insurance portability and accountability Act (HIPPA)

Established principles of patient privacy and confidentiality regarding use and misuse of their personal medical information and records, as well as standards for communication, storage and transmission of information.

In-migration - out migration

Movement of Labor's into or out of the geographic area within which a facility is recruiting for specific positions

Individual bargaining

Individuals with skills especially needed by a facility may be able to negotiate a higher wage than other employees in similar positions

In-service training

Seminars, online programs, DVD's, workshops, etc., offered during the work career of the employee.

Job analysis

The process of defining a position in terms of tasks or behaviors required specifying the qualifications of the employee to be assigned those duties

Job bidding

The practice of posting available jobs on bulletin boards and encouraging employees to apply or bid for openings

Key job comparison

A method of establishing wage rates for jobs based on comparing all jobs in the organization to a touchstone job in the facilities such as nursing.

Labor market

The geographic area from which applicants for positions are to be recruited

Leniency error

Consistently giving high ratings to all employees when evaluating employees in an attempt to avoid conflict

Life insurance

Some facilities offer free or shared fees for life insurance usually term type life insurance as a benefit. Term insurance features low premiums for high-dollar coverage, but has no cash, loan or other value

Line manager

Person responsible for performing most of the Personnel functions, who is delegated authority by the administrator to make decisions on his or her behalf and authority to commit facility resources

Manpower inventory

A projection of the present and future availability of qualified personnel and a number sufficient to meet facility needs

Mediation

Another concept that is related to facilities that are unionized. In this case the third party seeks to reach a settlement between the union and facility on an issue.

National Labor Relations Board

An organized panel set up to administer the process under the National Labor Relations Act under which unions become certified as the bargaining agent for groups of workers

Nepotism

Favoring ones family members and hiring practices

Performance centered objectives

Stating training goals in terms of behaviors that can be learned and observed by supervisors

Preliminary interview

A short questionnaire and interview used by some facilities to help screen out unsuitable applicants for a position

Prevailing wage rates

The wages paid by the predominant number of facilities in a community. Most businesses indicate they pay the prevailing wage rate or a competitive rate

Preventive Labor Relations

Maximizing the communication and facility acceptance by non unionized employees in hopes that they will feel no need to form a union to achieve their work goals

Progressive discipline

Do you serve a specified number of verbal then more Stern written warnings for each offense of the same rule before suspending or terminating an employee

Ratio hiring

Requirement by a government agency that an employer increase the proportion of women or minority persons in the employer's Workforce

Statistical approach to hiring

Identifying the most valid predictors of job success than using weights in a formula to choose among applicants for a position

Uniform guidelines on employee selection procedures

A publication of for federal agencies in 1987 setting standards by which federal agencies determine the acceptability of validation procedures used for written test and other selection devices

Weight class

Establishment of pay grades and rates the employer's to both achieve equity and offer some flexibility to supervisors in setting an employee's wage

Wage mix

Determination of wage rates that considering the labor market, prevailing wage rates, cost of living, ability to pay, collective bargaining agreements, individual bargaining agreements, and value of the job

Wage policy

Decisions by Management on the rate of pay for the facility staff the amount of discretion supervisors may use in setting individual salaries, the spread between pay rates for a long time and new employees, and the periods between pay raises together

Which one of the following is not a step used by management to deal with unexcused absences or excessive absenteeism by an employee?


A. Interviewing employee upon return to work


B.Stating policies after an infraction


C. Recognizing the workers positive work performance as a means of encouragement


D. Imposing penalties for unexcused and excessive absences

C. A worker would not be given praise for their work if they had excessive absenteeism as their work performance would not be positive if they were missing work

Nurses chatting casually about nursing matters in the nurses Lounge is an example of:


A. Formal communication


B. Upward communication


C. Downward communication


D. Informal communication

D. It is communication between professionals but the one clearly correct answer is informal communication

Which one of the following is a key factor in managing cultural diversity in the workforce?


A. Job roles


B. Job responsibilities


C. Education and training programs


D. And organizational chart

C. Establishment of cultural diversity education and training programs is a key factor in the management of cultural diversity issues in a long-term care facility

An abnormal condition or disorder caused by exposure either inhalation, absorption, ingestion, or direct contact to environmental factors associated with employment is:


A. Occupational injury


B. Musculoskeletal disorder


C. Violation of the Hazardous communication standard


D. Occupational illness

D. Occupational illness; it's not an occupational injury that would be a cut, fracture, spring or amputation that would require more than first aid.

To establish job descriptions the work the facility seeks to accomplish must be broken down and two sets of activities that can be:


A. Evaluated by supervisors


B. Performed by one person


C. Effectively analyzed


D. Grouped into job families

B. The point being tested is whether the respondent knows that all the work of a facility must be broken down into a set of activities that one person can perform

The Age Discrimination Act as amended:


A. Protected persons up to age 70


B. Prohibited mandatory retirement in most lines of work


C. Protected persons 40-70 from being laid off and replaced by younger workers


D. Prohibited hiring younger workers and releasing workers once they were eligible for Social Security

B. The original act sought to protect persons aged 40 through 70 from being replaced by the employer with younger person's, but the amendment addressed prohibiting mandatory retirement

The practice of giving verbal warnings followed by written warnings is known as:


A. Progressive discipline


B. Mandatory discipline


C. Enlightened discipline


D. Regressive discipline

A. Before severe action can be taken, such as a suspension, there must be a paper trail of warnings that are documented. Verbal reprimand would be first followed by a verbal and written warning the second time.

Which level of employees are most at risk for potential personal injury in the nursing home?


A. Food preparation workers


B. maintenance personnel


C. Certified nursing assistants


D. Nurses

C. The CNA is most at risk because of the nature of their work I'm a physical effort required, performing the same motions over and over while assuming positions that stress the body

What is the discipline that addresses musculoskeletal disorders and is directly related to staff that provide resident care?


A. Economics


B. Somatotypes


C. Ergonomics


D. Geometrics

C. Economics focuses on the distribution of goods and services while some at its height is the study of blood types and geometrics examines designs and shapes so that leaves the obvious which is ergonomics.

In the typical facility staff turnover is greatest among:


A. Business office personnel


B. Cna's


C. Dietary workers


D. Maintenance

B. CNAs; in most facilities that turnover of CNAs is noticeably higher than other staff categories

Which term is descriptive of a third party who makes a decision related to resolving a dispute and that decision is binding on both the union and the facility?


A. Mediation


B. Collective bargaining


C. Arbitration


D. Adverse impact

C. Mediation is to reach a settlement, collective bargaining is reaching an agreement between labor and the facility.

Which one of the following is a critical component of a human resource professional or Department?


A. Controlling


B. Organizing


C. Communicating


D. Planning

C. Communication is critical for the transmission and reception of information, it is an exchange of thoughts and messages. Effective management requires clear and concise communication.

Within the spirit of obra and culture change, which one of the following is most descriptive of the movement?


A. Resident rights and Resident centered care


B. Changing the physical structure of the facility to be more homelike


C. Having more clearly defined and permanent workloads and assignments


D. Protection of residents and employees through an affective infection control program

A. The spirit of obra and the culture change movement is to Accord more dignity to Residents, create a more resident centered care that allows the president to determine when they want to do things

Which one of the following is most descriptive of the Personnel policy handbook for human resources handbook?


A. Collation of job descriptions of all jobs in the facility


B. A compilation federal and state regulations that directly relate to each department in the facility


C. A compilation of culture change criteria that needs to be implemented to ensure quality resident-centered Care


D. A compilation of facility policies and procedures that directly relate to work conditions

D. The handbook describes work conditions directly relating to work Kama covers the rules and terms under which the employee was hired and the benefits.

For interviewing a potential employee, a good technique is to:


A. Spend half the time putting the interviewee at ease


B. Keep the interviewee on guard by asking a succession of rapid questions


C. Let the interviewee do most of the talking in order to gain as much information possible


D. Spend most of the time giving the interviewee information about the job

C. The purpose is to gain as much insight into the employee as possible options one two and four reduce information gained

Which of the following is the best approach for a supervisor to use with an employee who is clearly distracted and upset by a personal problem?


A. Issue a written warning


B. Ask the administrator to reprimand the employee


C. Discuss the problem with the employee as it relates to his or her job performance


D. Suspend the employee until the problem is resolved

C. Morning, reprimand, suspension are inappropriate responses to an employee upset by a personal problem. The employee needs to understand how the personal problem is impacting his or her work performance and seek help outside the facility to resolve the problem.

Which of the following is not a mechanism for overcoming barriers in communication?


A. Use Simple language


B. Depend on key persons in each department or unit to interpret the information


C. Connect new ideas with familiar ones


D. Provide an opportunity for feedback on information that is not clear

B. An administrator or supervisor should not depend on others to interpret a message. If someone is unsure about the message communicated he or she should schedule an appointment with the messenger to discuss what was said or understood to be said

________ communication occurs between peers or persons of equal rank or status.


A. Downward


B. Formal


C. Upward


D. Horizontal

D. Downward refers to supervisors to staff or administrator to supervisors, formal is along the lines of the organizational chart, and upward is from the employee to the supervisor

Which type of employee counseling should not be done between the administrator or department manager and an employee?


A. Personal development and career advancement


B. Personal non-work problems being experienced by an employee


C. Work-related problems like scheduling, the work environment, work performance


D. Conflicts between personnel, managers and employees or employee and employer or administrator and employee

B. Only trained professionals should assist an employee on problems outside of the work area. Getting involved in personal problems outside the work area has the potential to cause additional problems down the road

Which one of the following is the most important step in developing clearly defined job descriptions?


A. Having all job descriptions written by lines supervisors


B. Careful analysis of the job content


C. Containing sample job descriptions from Allied professions


D. Updating the job description to reflect changes in compensation policies

B. None of the steps suggested and one, three and four would lead to a clearly defined job description

Which one of the following is the most significant factor related to employee retention?


A. Development of Master Staffing schedule


B. Advisory relationships with consultants


C. Orientation and supervision of employees


D. Strict adherence to policy and procedures

C. Employees who are fully oriented to their job armoire to remain with the facility. Steps A, B and D would not likely lead us directly to better employee retention

The requirement that all employers including government agencies must verify that employees hired are either US citizens or authorized to work in the u.s. is part of the:


A. Social Security Act


B. Fair labor standards Act


C. Immigration reform and Control Act


D. Health insurance portability and accountability Act

C. Are you sharing reform and Control Act which requires employers to fill out an I-9 form for every employee

Regulations related to payment for overtime for nursing staff employed by a Skilled Nursing Facility are Guided by the:


A. Immigration reform and Control Act


B. Workers compensation act


C. Medicare modernization Act


D. Fair labor standards Act

D. Fair labor standards act which sets minimum wage, overtime, standard work week definition equal pay, child labor, and record-keeping requirements for over 50 million employees including those in nursing homes

Which act is directly related to questions that the administrator or human resource representative can ask in an interview with a client?


A. Fair labor standards Act


B. Uniform service employment and Reemployment Act


C. Civil Rights Act


D. The health insurance portability and accountability Act

C. Civil Rights Act seeks to protect applicants for a position from discrimination and being considered for a position

Budget (Financial planning)

A budget is based on the goals and priorities of the organization and expresses them in statistical and monetary terms it also describes how resources will be allocated to achieve these goals, provides criteria for measuring goal achievement, facilitates the coordination of individual efforts into an overall plan, is based on historical Trends in the organization, and represents Management's predictions on how internal and external changes will affect the facility's future utilization and financial performance.

What are the four types of budgets?

Operating budget, revenue budget, capital budget, and cash budget.

Operating budget

The operating budget includes all planned revenues by source and all anticipated expenses by natural classification such as salaries and wages, supplies, utilities, taxes, etc.

Revenue budget

The preparation of the revenue budget is the role of top management staff and entails the protection of Patient Service revenues as well as other operating and non-operating revenues such as revenues from Investments, sale of assets, and donations and endowments.

Capital budget

A capital budget is a plan that shows major Capital expenditures for new equipment or buildings and for the replacement or modernization of existing equipment and facilities