SMQT EXAM /APPROVED SMQT EXAM 2026/2027 COMPREHENSIVE
PRACTICE QUESTIONS AND STUDY GUIDE COMPLETE ACCURATE EXAM
1. During a long-term care facility survey, a surveyor reviews the medical
record of a resident who has experienced repeated falls during the previous
month and discovers that the facility documented each incident but did not
consistently assess contributing factors, update the care plan, or implement
interventions after the first fall. Which survey finding would most directly
support a concern about the facility's ongoing responsibility for this
resident?
A. The resident's family was not contacted after every minor incident
B. The facility failed to translate identified risks and changing needs into
appropriate individualized interventions
C. The resident had a history of falls before admission to the facility
D. The resident declined participation in one recreational activity
Answer: B
2. A surveyor is evaluating whether a nursing facility has accurately identified
the needs of a resident admitted with diabetes, chronic kidney disease,
impaired vision, and limited ability to communicate. The record contains
extensive physician orders, but the nursing documentation does not
demonstrate that staff consistently assessed the resident's functional
abilities or monitored changes in condition. Which principle should guide
the surveyor's evaluation?
A. Physician orders automatically establish that all resident needs are being
addressed
B. The presence of a diagnosis is sufficient evidence that an individualized
plan exists
C. The facility must demonstrate that assessment information is translated
into individualized care and services
D. Nursing documentation is unnecessary when laboratory values remain
within expected ranges
Answer: C
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, 3. While reviewing medication administration records, a surveyor notices that
a resident prescribed an anticoagulant received the medication at
inconsistent times on several occasions, and the record contains no
explanation for the deviations. The resident subsequently developed
abnormal bleeding. What should the surveyor examine first when
determining the significance of this finding?
A. Whether the facility had systems to safely administer and monitor the
medication according to the resident's needs
B. Whether the resident's room was located near the medication room
C. Whether the resident participated in the facility's social activities
D. Whether the resident's family supplied any over-the-counter medications
Answer: A
4. During an interview, a resident states that staff routinely enter the
resident's room without knocking, even when the resident is changing
clothes or receiving personal care. Several staff members confirm that they
commonly enter rooms without waiting for permission. Which resident-
rights principle is most directly implicated?
A. The resident's right to refuse participation in activities
B. The resident's right to choose a physician
C. The resident's right to receive telephone calls
D. The resident's right to privacy and respectful treatment
Answer: D
5. A surveyor observes a nursing assistant transferring a frail resident from bed
to wheelchair without using the transfer technique identified in the
resident's care plan. The resident has a documented history of orthostatic
hypotension and previous transfer-related dizziness. What is the most
appropriate surveyor focus?
A. Whether the resident prefers a different wheelchair color
B. Whether the staff member followed the individualized safety measures
established for the resident
C. Whether the resident's family approved the transfer technique
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, D. Whether the facility's activity calendar included exercise that day
Answer: B
6. A resident with dementia repeatedly attempts to leave the secured unit.
The facility has documented the behavior but has not investigated possible
triggers, assessed the resident's needs, or developed individualized
interventions. Which concern is most strongly supported?
A. The resident should automatically be discharged
B. The resident should be denied access to activities
C. The facility may be failing to assess and address an identified behavioral
and safety need
D. The resident's family must provide all behavioral interventions
Answer: C
7. During a facility survey, a resident reports that staff frequently tell residents
they cannot complain because doing so will cause staff members to become
angry. The surveyor interviews other residents and finds similar statements.
Which issue should receive the greatest attention?
A. Potential interference with residents' rights to voice grievances without
fear of retaliation
B. Lack of variety in recreational programming
C. Insufficient dietary choices
D. Inadequate transportation scheduling
Answer: A
8. A surveyor reviews a pressure-injury prevention program for a resident who
is immobile and incontinent. The record identifies the resident as high risk,
but staff cannot explain the resident's repositioning schedule, skin-
monitoring process, or individualized nutritional interventions. Which
conclusion is most appropriate?
A. Risk identification alone establishes compliance
B. The resident is responsible for developing the prevention plan
C. Pressure injuries are unavoidable in immobile residents
D. The surveyor should determine whether the facility implemented an
3
, effective individualized prevention strategy
Answer: D
9. A nursing home receives a resident with a documented history of aspiration
and swallowing difficulty. The speech-language evaluation recommends a
specific diet consistency and positioning technique. During observation,
staff provide food inconsistent with the recommendation and position the
resident improperly. What should the surveyor consider?
A. Whether the resident requested dessert
B. Whether staff implemented ordered and care-planned precautions
designed to reduce aspiration risk
C. Whether the dining room had adequate decorations
D. Whether the resident ate independently before admission
Answer: B
10. During an interview, a nurse states that changes in a resident's mental
status are expected because the resident is elderly and therefore do not
always need to be reported. The medical record shows several episodes of
acute confusion that were not communicated to the provider. Which survey
concern is most appropriate?
A. The facility may be failing to recognize, evaluate, and report significant
changes in condition
B. The resident should automatically receive a psychiatric diagnosis
C. The resident's family should independently diagnose the condition
D. Acute confusion is always an expected consequence of aging
Answer: A
11. A surveyor discovers that a facility has a policy requiring staff to notify the
physician when a resident experiences a significant change in condition.
Interviews reveal that staff members know the policy but routinely delay
notifications until the next scheduled physician visit. Which evidence is
most important in determining whether the facility has a systemic problem?
A. The color of the facility's policy manual
B. Whether the physician has an office in the same building
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PRACTICE QUESTIONS AND STUDY GUIDE COMPLETE ACCURATE EXAM
1. During a long-term care facility survey, a surveyor reviews the medical
record of a resident who has experienced repeated falls during the previous
month and discovers that the facility documented each incident but did not
consistently assess contributing factors, update the care plan, or implement
interventions after the first fall. Which survey finding would most directly
support a concern about the facility's ongoing responsibility for this
resident?
A. The resident's family was not contacted after every minor incident
B. The facility failed to translate identified risks and changing needs into
appropriate individualized interventions
C. The resident had a history of falls before admission to the facility
D. The resident declined participation in one recreational activity
Answer: B
2. A surveyor is evaluating whether a nursing facility has accurately identified
the needs of a resident admitted with diabetes, chronic kidney disease,
impaired vision, and limited ability to communicate. The record contains
extensive physician orders, but the nursing documentation does not
demonstrate that staff consistently assessed the resident's functional
abilities or monitored changes in condition. Which principle should guide
the surveyor's evaluation?
A. Physician orders automatically establish that all resident needs are being
addressed
B. The presence of a diagnosis is sufficient evidence that an individualized
plan exists
C. The facility must demonstrate that assessment information is translated
into individualized care and services
D. Nursing documentation is unnecessary when laboratory values remain
within expected ranges
Answer: C
1
, 3. While reviewing medication administration records, a surveyor notices that
a resident prescribed an anticoagulant received the medication at
inconsistent times on several occasions, and the record contains no
explanation for the deviations. The resident subsequently developed
abnormal bleeding. What should the surveyor examine first when
determining the significance of this finding?
A. Whether the facility had systems to safely administer and monitor the
medication according to the resident's needs
B. Whether the resident's room was located near the medication room
C. Whether the resident participated in the facility's social activities
D. Whether the resident's family supplied any over-the-counter medications
Answer: A
4. During an interview, a resident states that staff routinely enter the
resident's room without knocking, even when the resident is changing
clothes or receiving personal care. Several staff members confirm that they
commonly enter rooms without waiting for permission. Which resident-
rights principle is most directly implicated?
A. The resident's right to refuse participation in activities
B. The resident's right to choose a physician
C. The resident's right to receive telephone calls
D. The resident's right to privacy and respectful treatment
Answer: D
5. A surveyor observes a nursing assistant transferring a frail resident from bed
to wheelchair without using the transfer technique identified in the
resident's care plan. The resident has a documented history of orthostatic
hypotension and previous transfer-related dizziness. What is the most
appropriate surveyor focus?
A. Whether the resident prefers a different wheelchair color
B. Whether the staff member followed the individualized safety measures
established for the resident
C. Whether the resident's family approved the transfer technique
2
, D. Whether the facility's activity calendar included exercise that day
Answer: B
6. A resident with dementia repeatedly attempts to leave the secured unit.
The facility has documented the behavior but has not investigated possible
triggers, assessed the resident's needs, or developed individualized
interventions. Which concern is most strongly supported?
A. The resident should automatically be discharged
B. The resident should be denied access to activities
C. The facility may be failing to assess and address an identified behavioral
and safety need
D. The resident's family must provide all behavioral interventions
Answer: C
7. During a facility survey, a resident reports that staff frequently tell residents
they cannot complain because doing so will cause staff members to become
angry. The surveyor interviews other residents and finds similar statements.
Which issue should receive the greatest attention?
A. Potential interference with residents' rights to voice grievances without
fear of retaliation
B. Lack of variety in recreational programming
C. Insufficient dietary choices
D. Inadequate transportation scheduling
Answer: A
8. A surveyor reviews a pressure-injury prevention program for a resident who
is immobile and incontinent. The record identifies the resident as high risk,
but staff cannot explain the resident's repositioning schedule, skin-
monitoring process, or individualized nutritional interventions. Which
conclusion is most appropriate?
A. Risk identification alone establishes compliance
B. The resident is responsible for developing the prevention plan
C. Pressure injuries are unavoidable in immobile residents
D. The surveyor should determine whether the facility implemented an
3
, effective individualized prevention strategy
Answer: D
9. A nursing home receives a resident with a documented history of aspiration
and swallowing difficulty. The speech-language evaluation recommends a
specific diet consistency and positioning technique. During observation,
staff provide food inconsistent with the recommendation and position the
resident improperly. What should the surveyor consider?
A. Whether the resident requested dessert
B. Whether staff implemented ordered and care-planned precautions
designed to reduce aspiration risk
C. Whether the dining room had adequate decorations
D. Whether the resident ate independently before admission
Answer: B
10. During an interview, a nurse states that changes in a resident's mental
status are expected because the resident is elderly and therefore do not
always need to be reported. The medical record shows several episodes of
acute confusion that were not communicated to the provider. Which survey
concern is most appropriate?
A. The facility may be failing to recognize, evaluate, and report significant
changes in condition
B. The resident should automatically receive a psychiatric diagnosis
C. The resident's family should independently diagnose the condition
D. Acute confusion is always an expected consequence of aging
Answer: A
11. A surveyor discovers that a facility has a policy requiring staff to notify the
physician when a resident experiences a significant change in condition.
Interviews reveal that staff members know the policy but routinely delay
notifications until the next scheduled physician visit. Which evidence is
most important in determining whether the facility has a systemic problem?
A. The color of the facility's policy manual
B. Whether the physician has an office in the same building
4
