NAB Exam 2023 Questions with correct Answers

5 essential ADLs - ANSWER-eating, dressing, toileting, bathing, transferring RUGs - ANSWER-Resource Utilization Categories MDS - ANSWER-Minimum Data Set RAPs - ANSWER-Resident Assessment Protocols RI - ANSWER-Resident Assessment Instrument Includes: Id and demographic info; routine; cognitive pattern; communication; vision; mood/behavior; psychosocial; physical/structural; continence; diagnoses and health conditions; dental/nutritional statue; skin condition; activity pursuits; dc potential; documentation of summary info regarding RAPs; documentation of participation in assessment. Process must include observation; resident communication; communication with direct care staff on all shifts. Complete w/i 14 days of admission (excludes readmission w/no significant change in condition); w/i 14 days of significant change in status; no less than every 12 months. Quarterly Assessments - ANSWER-Required every 3 months. Assessments - ANSWER-Prior 15 months worth kept in med record. Must be encoded and able to transmit within 7 days of completion--admissions, annuals, quarterlies, significant changes, subset for resident transfer/reentry/dc/death; and/or, face-sheet info if no admission assessment. Must transmit monthly all prior month assessments. RN must coordinate assessments w/ participation of other health professionals RN must sign and certify complete and accurate. Individuals completing sections must sign and certify accurate and complete. Penalty for falsifying up to $1000, causing others to falsify up to $5000 per assessment. Care plan - ANSWER-Must be comprehensive and written with measurable goals/timetables and include services provided and refused by exercising of rights. Completed within 7 days of assessment by interdisciplinary team. Include resident and family. Reviewed/revised after each assessment. Pharmacy Consultant Review - ANSWER-Monthly review of medications for residents. Irregularities reported to attending and DON. Calculation for raw food cost - ANSWER-cost per resident per day x census Exit signs & lights - ANSWER-90 minute battery or on generator Tested monthly Duration test yearly fire extinguishers - ANSWER-inspected monthly annual servicing disaster drills - ANSWER-two times per year Fire drills - ANSWER-once per shift per quarter fire sprinkler inspections - ANSWER-quarterly smoke detector inspections - ANSWER-two times per year electrical panel - ANSWER-18 inches right/left 36 inches in front--floor to ceiling building temps - ANSWER-not to exceed 81 (typically 68 or 72 min) means of egress - ANSWER-8 feet unobstructed exterior must have a light and be navigable accessing a public walkway generator - ANSWER-run weekly under load monthly fire alarm tests - ANSWER-monthly (full audible and visual) extension cords/multiple outlet strips - ANSWER-none at all, strips for computer peripherals only dryers - ANSWER-lint traps cleaned every 3 loads or every 2 hours Medication Rooms - ANSWER-Can't exceed 77 degrees Must be locked Oxygen Rooms - ANSWER-Non combustible floor &/or in room Switch 60 inches above the floor or outside of room Vented directly to outside Must be locked Signage--"transfer in progress" & "door must remain closed during transfer" (as app); "no smoking"; "oxygen in use" Tanks must be secured (top ⅓ of tank or approved holder) Smoking Areas - ANSWER-Extinguisher present Self closing metal ashtray Metal, self-closing disposal container Non combustible furnishings Signage: No smoking within 5 feet of oxygen use & No smoking while Oxygen in use Must be designated as smoking area Non combustible landscaping within 15 feet Enclosed courtyard - ANSWER-Must have "No Exit" sign Delayed egress device - ANSWER-must drop out immediately upon activation of smoke/fire alarm alarm must sound within 2 seconds and door must release in 30 seconds once pressure is applied one delayed egress device in path of egress (ie only one set of doors can be delayed until you get outside) Fire evac plan - ANSWER-Post at each exit door Protrusions in hallways - ANSWER-No more than 6 inches Resident Rights - ANSWER-Must inform orally and in writing, in a language understood rights Review record w/i 24 hours (excluding holidays & weekends) Receive copies of record w/i 2 days Must provide written info on: protection of funds, medicaid requirements/eligibility including spousal impoverishment info, names/addresses/phone info of state client advocacy groups/licensure office/ombudsman/protection & advocacy network, Medicaid fraud control unit, and statement res may file complaint with state re: resident abuse, misappropriation of property, non-compliance with advance directives reqs. Must provide physician information for contact Must provide oral/written info on how to apply for Medicare/Medicaid benefits Must notify resident/family when accident occurs resulting in injury or potential for physician contact; significant change; need to alter tx significantly; or need to transfer/discharge res from facility; Change in resident room or roommate; Change in resident rights Deposit of funds: >$50 must be held in interest bearing account; no co-mingling of resident funds with facility funds or others aside from residents only. Must provide statement of individual account quarterly & upon request. Must notify Medicaid residents when funds approaching $200 or resource limit and that exceeding resource limit may lose eligibility for Medicaid. Must convey final balance within 30 days of death. Facility must provide assurance of funds security. Must inform res/family of items for which charge will be incurred and amount. Free Choice and Privacy/Confidentiality: choose own dr, participate in care plan, deny release of records (unless transfer related or req'd by law) Examination of most recent survey and plan or correction--must be posted as available Private correspondence and telephone use. Self-administer medication when interdisciplinary team deems safe. Transfer/Discharge - ANSWER-Must permit resident to remain in facility and not transfer or discharge unless: medically necessary, when health improved and services no longer needed, safety or health of others is endangered, res failure to pay (after reasonable notice), facility ceases to operate. Clinical record must be documented by physician. Must notify resident and/or legal rep in writing of transfer and reason specified above, and document notice given in med record. Must provide 30 days notice of transfer/discharge unless b/c: medically necessary; health/safety of residents endangered; health improved; resident in facility <30 days. Written notice must include: reason; effective date of transfer/dc; location to which res is transferred/dc'd; right to appeal to state; name/address/phone of ombudsman; info for developmental disabilities or mentally ill protection/advocacy groups for those facilities. Must provide sufficient preparation and orientation regarding transfer/dc. Bed Hold Policy and Readmission - ANSWER-Must provide written info including duration of bed hold policy and bed hold period prior to transfer to hospital or therapeutic leave; and at time of transfer must provide written notice specifying duration of bed hold. If leave exceeds bed hold, facility must have written policy addressing readmission immediately upon first availability of a bed in a semi-private (if res requires facility services and is eligible for Medicaid). If composite distinct part--must be returned to same area or given option of returning to that location upon first available bed. Activities Program - ANSWER-Must be directed by qualified professional: qualified therapeutic rec specialist (licensed/registered by the State and is eligible for certification as a therapeutic rec specialist or activities professional by recognized accrediting body; OR, has 2 yrs experience in social or recreational program within last 5 years, one of which was full time in a patient activities program in healthcare setting; OR is a qualified OT or OTA; OR, has completed a training course approved by State. Social Services - ANSWER-Must provide medically-related social services for physical, mental and psychosocial wellbeing of residents (>120 beds must have full-time). Qualified SW has Bachelor's degree in social work or human service field; AND, 1 yr supervised social work experience in health care setting working directly with individuals. Environment - ANSWER-Homelike, safe, clean and comfortable. May bring personal possessions and furniture provided safe and room. Temps must be maintained between 71-81 degrees F. Discharge Summary - ANSWER-Includes recap of resident's stay/care; final summary of resident status, post-discharge plan of care. Pre Admission Screening for mentally ill and mental retardation - ANSWER-SNF/NF may not admit new resident with mental illness or mental retardation unless State authority has determined (by independent evaluation performed by third party) that individual requires level of services provided by facility and whether individual requires specialized services. Antipsychotic Drugs - ANSWER-Only to tx specific and documented conditions. Must have gradual dose reductions and behavioral interventions unless clinically contraindicated. Med Errors - ANSWER-Must be <5% and ensure residents are free of errors Influenza/Pneumococcal Immunizations - ANSWER-Must have P&Ps that ensure: resident and/or families are educated regarding benefits and potential side-effects; offered to all October 1 thru March 31 annually (flu vacc) unless medically contraindicated or resident already immunized during time period; resident and/or family has right to refuse; med rec must indicate info provided to res/families, res received or not d/t medically contraindications or refusal. Pneumoccocal P&P ensures all of above with resident having received already unless, based on assessment or practitioner recommendation, a second vacc may be given after 5 years following first immunization--unless contraindicated or refused. Nursing Services - ANSWER-Must provide 24 hour nursing care unless state waived (see below). Licensed nurse as charge nurse on each tour of duty. Full-time, RN as DON--may serve as charge nurse only if avg daily occupancy is <60 residents. Waiver of 24 hour licensed nurse: demonstrates inability to recruit adequate staff; will not endanger residents; RN or physician is obligated to respond immediately to phone calls from NF (when no licensed nurse on duty); waiver subject to annual review; Ombudsman notified; facility must notify residents and families of waiver. Waiver of RN for more than 40 hours per week: rural area and supply of SNF services in area is not adequate to meet needs of area residents; RN is regularly on duty 40 hours per week; has only patients whose physicians document no RN need for 48 hour period; facility has arranged for RN or physician to spend time at facility as needed on days when no regular RN is scheduled; subject to annual review, Ombudsman notified; facility must notify residents and families. Nurse Staffing - ANSWER-Daily basis: name of facility, current date, number of RNs/LPNs/CNAs per shift, resident census. Nurse staffing data must be posted on a daily basis at the beginning of each shift in a location visible to residents and visitors. Must make staffing data available to public upon oral or written request at a cost not exceeding community standard. Must maintain records for 18 months, or as required by state law--whichever is greater. Dietary Services - ANSWER-Must have dietician at least consultant basis--if not full-time then Director of food service must have consultation regularly. Menus must meet nutritional needs and follow Food and Nutrition Board of National Research Council, National Academy of Sciences; be prepared in advance; must be followed. Three meals daily: no >14 hours between evening and breakfast meals unless bedtime snack is offered--then 16 hours. Must offer daily bedtime snacks. Must provide assistive devices and therapeutic (physician ordered) meals. Feeding Assistants - ANSWER-May be used if allowed by state law and meet state training guidelines. Must be supervised by RN or LPN. Must call RN/LPN in emergency on resident call system. Only residents with no complications--difficulty swallowing, aspiration history and tube or parenteral IV feeding. Must have charge nurse assessment and plan of care review to select. Physician Services - ANSWER-Must have written recommendation from physician for admission. All residents must be under physician care, alternate physician supervision when primary is unavailable. Must be seen every 30 days for first 90 days; once every 60 days thereafter. Visit is considered timely if within 10 days of due date. After initial visit, may alternate physician with PA, NP or clinical nurse specialist. Write, sign and date Progress Notes with each visit. Sign and date all orders with exception of influenza/pneumococcal vaccs which can be administered per physician approved facility policy after contraindication assessment. Facility must provide for physician servicer 24 hours a day, for emergency coverage. Infection Control - ANSWER-Facilities req'd to establish and maintain infection control program which addresses investigation, controls and prevents infections; addresses isolation procedures; maintains records of incidents and corrective actions related to infections. Staff must wash hands after each direct resident contact. Employees with communicable diseases and open skin lesions prohibited from direct contact with residents or food. Linens must be handled, stored, transported and processed to prevent spread of infection. Physical Environment: Resident Rooms - ANSWER-No more than 4 residents. Semi: 80 sq. ft. per resident Private: 100 sq. ft. per resident Assure full visual privacy for each resident (ceiling suspended curtains) Direct access to exit corridor 1 window to outside At or above grade Individual closet space Resident Call Systems - ANSWER-Resident Rooms and Toilet/Bathing Rooms Other Physical Environment - ANSWER-Handrails on each side of hallways Effective pest control program Procedures to ensure water available when supply disrupted. Adequate outside ventilation--windows, mechanical vents, or combo of two. Nurse Aid Training - ANSWER-Can't use anyone as NA for >4 months full-time unless completed training per State. Must receive registry verification of competency requirements unless: Full-time emp in a state training and competency program; or emp can prove they have completed state training and competency program and haven't been added to the registry yet--facility must follow-up to ensure emp becomes registered. Must verify every state registry emp has been included in. New training and competency evaluation program must be completed if more than 24 consecutive months with no NA practice. Facility must review performance every 12 months and provide inservicing for areas of weakness--at least 12 hours minimum per year and address cognitive impairment. Medical Director - ANSWER-Facility must designate Medical Director responsible for resident care policy implementation and coordination of medical care in facility. Medical Records - ANSWER-Retain according to State law; OR, 5 years from discharge when no State requirement; OR, for a minor--3 years after reaching legal age under State law. Must be kept confidential. Must be secured against loss, destruction or unauthorized use. Must contain: resident identification information, assessments, care plans and services provided, pre admit screening conducted by state, and progress notes. Quality Assessment/Assurance - ANSWER-Must maintain QA committee including DON, designated facility physician, at least 3 other staff members. Meets quarterly to id issues and develop plans of action to correct identified deficiencies. Surveyors may only require as related to compliance of committee with requirements stated here. Good faith attempts to correct may not be used as basis for sanctions. Disclosure to State - ANSWER-Change in ownership, controlling interest, management, administrator or DON in writing and include identity of indivi