Federal Nursing Home Administrator Exam 2024 Questions With Complete Solutions.

1) OBRA asserts some separate committees can be folded into the quality improvement/assurance committee. Safety, Pharmacy and which committee below can be added into QA/QI committee? - ANS Infection Control 2) Nursing homes are responsible for obtaining and providing dental care for residents. Who usually pays for dental services? - ANS The resident or a family member 3) A facility is not allowed to charge a resident who is Medicaid and Medicare eligible except for: - ANS Co-pays 4) You calculate the average percent of occupancy by: - ANS Dividing the total census (occupied bed days) by the total number of days, then multiply by 100 5) Resident's rights should be explained to the resident and or family member: - ANS Prior to admission 6) In case of an emergency, when no attending or back up physician is available, the decision as to who will attend to the resident is to be made by the: - ANS Administrator 7) Federal law states that facilities must retain menus of food actually served for at least: - ANS 30 days 8) A resident with a living will and DPOA specified she wants to receive heroic measures if necessary. Six months later the resident requires CPR, but is now incompetent and the son request CPR be withheld. What is the right thing to do? - ANS Provide the CPR 9) A resident asks to see his chart. The doctor tells the nurse not to allow the resident access to the chart. What do you do? - ANS Tell the doctor the law gives the resident the right to view the medical records 10) Medical records belong to: - ANS Facility 11) When a resident passes away, the personal funds deposited with the facility must be given to the resident's estate with a final accounting of the funds within: - ANS 30 days 12) The suffix "algia" refers to: - ANS Pain 13) Physical restraints must be removed: - ANS Every two hours 14) Depression is one of many psychological changes related to the aging process. Others include the following except for: - ANS Hearing loss 15) "Nosocomal" refers to - ANS Infection occurring inside the facility (institutionalized) 17) A capital budget is mostly about: - ANS Equipment and real estate 18) Current debts are debts that are: - ANS Due within one year 19) A ledger is a complete listing of: - ANS Accounts payable and receivable 20) Which resource usually provides the least revenue for a nursing home? - ANS Insurance 20) Past due accounts should not exceed: - ANS 5% 21) All of the following are a cash expense except: - ANS Depreciation 22) A pro forma is primarily - ANS A financial statement or prediction 23) A function of management is controlling, which means: - ANS Measuring outcomes against benchmarks, then responding 24) OBRA requires every facility to have: - ANS A governing body - The Omnibus Reconciliation Act 25) Management by objectives means: - ANS A system that determines goals and objectives 26) Policies are: - ANS General and flexible statements that guid thinking 27) Procedures are: - ANS Not flexable 28) Short range (tactical) goals can be accomplished - ANS In less than one year 29) Policies should be developed by the: - ANS Governing body 30) The charge nurse is considered - ANS Line level management 31) McGregor's Theory X and Theory Y discuss individual's: - ANS Employees's attitudes towards work 32) Decision making requires all of the following except: - ANS Controlling behavior 33) Public relations has been defined as: - ANS The management of communications 34) Strategic Planning is: - ANS Long term plans based on the organizations overall business objectives 35) Marketing should: - ANS Increase and maintain census 36) Keys to success in reducing turnover are all except: - ANS Scheduling 37) Which is not a recognized type of management? - ANS Scalar Chain Management 38) Unity of Command is: - ANS Each person reports to one supervisor 39) Speed is a communication barrier because, on average, a person speaks 180 words per minute, but thinks at: - ANS 300 words per minute 40) The most overlooked aspect of communication in health facilities is: - ANS Two way feedback loops 41) Of the following, the task management performs that contribute most effectively and positively to morale is: - ANS Discipline consistentlyr and fairly 42) In a bargaining unit, only ____ need to sign a card to call a union election: - ANS 30 percent 44) During an interview or on a job application, you may ask for all except: - ANS Place of Birth 45) To be eligible for FMLA, an employee must first work - ANS 1250 hours in the last 12 months 46) If an employee works 52 hours in one week at a rate of $7 per hour, what would be the total gross salary? - ANS $406 47) Fire safety regulations come primarily from: - ANS LSC Life Safety Code 48) The purpose of an enunciator panel is to: - ANS Indicate the zone of a fire 49) Generators must be checked - ANS montly 50) Employee's Right to know refers to - ANS Hazardous communicatins 51) The primary fire - defense tools of a nursing home staff are: - ANS Smoke barriers, corridor walls, and resident rooms 52) A maintenance program that saves time and money focuses on: - ANS Preventive maintenance 53) Class C fires involve: - ANS Electricity PHYSICAL ENVIRONMENT ANT ATMOSPHERE - ANS PHYSICAL ENVIRONMENT ANT ATMOSPHERE - ANS 54) Indoor temperatures - ANS 71 - 81 degrees ferinhight 55) Disaster plans - ANS OBRA requirement for written plan 56) Life Safety Code - ANS Reasonably ensure the public protection from fire in public buildings 57) MSDS - ANS Information on potentially hazardous material 58) OSHA - ANS federal agency overseeing employee safety 59) NFPA - ANS establishes LSC 60) Personnal Protective Equipment - ANS gloves 61) Preventative measures - ANS time for schedules repairs 62) Offer HBV - ANS within 10 working days 63) Smoke compartments - ANS 200 feet or less 64) Occupant loads for exit requirements: - ANS one person per 120 sq ft of floor area in sleeping areas and one person per 240 sq ft in treatment areas 65) Means of Egress Requirements Emergency lighting: - ANS Mandatory and Automatically available not requiring manual intervention for continuous operation when power is interupted 66) Means of Egress Requirements Exit Marking: - ANS clearly marked with signs no more than 100 feet from exit 67) Emergency Power: - ANS Check generator weekly, test under full load for 30 minutes monthly 68) Handrails at bottom of stairs must be: - ANS extended parallel to floor for 12 inches 69) Windows must have opening force requirement: - ANS of no more than 5 lbs. 70) Generator should provide for full load for - ANS 4 hours, under emergency power need 71) Resident rooms - ANS No more than 4 residents per room 80 sq ft per resident in multi-bed rooms 100 sq ft in private room window to outside 72) OBRA requires housekeeping services necessary to - ANS maintain a sanitary, orderly, and clean interior 73) Exposure Control Plan must be updated - ANS Annually HUMAN RESOURCES - ANS 74) Bargaining Unit - ANS Workers identified by NlRB to form a group to unionize 75) Construct Validity - ANS Extent to which a tool measures a trait important to job performance 76) Line management - ANS Performs personnel functioned, delegated authority to make decisions 77) Skill Analysis - ANS identification of attributes required to 78) Task Analysis - ANS review of job description 79) Employee Handbook - ANS Policies related to work conditions 80) Career Path - ANS Avenues for upward mobility within organization 81) Progressive Discipline - ANS Use of specific number and type of warnings 82) Job description - ANS list of duties and responsibilities 83) COLA - ANS Group of temporary workers 84) Election for unionization - ANS Conducted by NLRB 85) FLSA - ANS minimum wage 86) Halo Effect - ANS One trait colors all performance 87) In-Out migration - ANS Movements of workers in and out of geographic area 88) Pool - ANS Group of temporary workers 89) Labor Market - ANS geographic area of recruitment 90) Union election - ANS NLRB conducts; 50% plus 1 potential bargaining unit members VOTING wins LEADERSHIP AND MANAGEMENT (23% - 35 questions) - ANS 91) Strategic Planning - ANS setting long term goals 92) Case mix - ANS residents categorized by acuity 93) Governing body - ANS legally responsible for management 94) Tactical planning - ANS selecting goals for one year 95) Management - ANS achieve common goals thru organization 96) Market segment - ANS potential users of services 97) Payor mix - ANS residents categorized by payment type 98) Rules - ANS commands for action or non-action 99) Procedures - ANS required methods for handling activities 100) Risk management - ANS proactive means of anticipating problems 101) Staff authority - ANS advisory relationship with line management 102) Forecasting - ANS projects trends and needs which facility management must decide in future economic, social and political environment expected and resources available. 103) Bench Marking - ANS improve business by comparing with best practice of others (standards from which you measure) 104) Upper-Level management - ANS responsible for the overall functioning of the facility, normally interacting directly with the Board of Directors and/or owners. 105) Middle-Level management - ANS report to upper-level while interacting with lower-level (DON) 106) Lower-level management - ANS directly supervise the staff who do the actual work 107) Line Position (Authority): - ANS empowered by administrator to make decisions for organization (DON can fire, fire, give orders) 108) Staff Position (Authority) - ANS not empowered to make decisions; duties are primarily to advise (consultants, pharmacists, accountants, etc.) 109) Functional Authority - ANS action outside the normal lines of authority 1. Violates unity of command 2. Necessary due to principle of exception The two often have edges of distinction blurred 110) Actionable - ANS conduct giving rise to legal action 111) Aggrieved party - ANS one whose rights invaded or who suffered injury 112) Burden of proof - ANS obligation of person bringing action 113) Liable - ANS written defamation 114) Slander - ANS verbal defamation 115) Malice - ANS intentional doing of wrongful act 115) Tort - ANS a wrong: legal duty owed, breached, and harm occured 116) Worker Comp: - ANS responsible for injuries occurring at work 117) Scope of Employment: - ANS range of employee activities (resident services by omission or commission) 118) Governing: - ANS excersis authority 119) Advisory: - ANS not binding 120) Stewardship: - ANS accumulation and use of assets 121) Planning and monitoring: - ANS goals and progress 122) Determining Facility Objectives: - ANS measurable, verifiable, and attainable 123) Governing Body: - ANS Approval of P & P Approval of budget Selection and Appraisal of Administrator FINANCE (14% - 21 questions) - ANS 124) Accounting Equation - ANS Assets = Liabilities + Capital 125) Accounts payable - ANS Amounts owed by facility 126) Balance Sheet - ANS Statement showing solvency 127) Solvency - ANS the ability of a corporation to meet its long term fixed expenses and to accomplish long-term expansion and growth 128) General ledger - ANS Summaries entries in each journal for accounting period 129) Cost Center - ANS Organizational unit whose costs are separately accumulated 130) Accrual - ANS Record revenue when entered; expenses when incurred 131) Functional Accounting - ANS Recording aggregated data for related activities 132) Aggregated - ANS formed by the conjunction or collection of particulars into a whole mass or sum; total; combined 133) Contractual Discount - ANS Uncollectible difference between charges and third party payor agreements 134) Depreciation - ANS spreading of cost of capital assests over useful life 135) Operating Statement - ANS total revenues - total expenses =net income (loss)138) 136) Working Capital - ANS Current assets - current liabilities 137) Entity Concept: - ANS The facility, its records and monies are separate from owners. Ensuring consistency in accounting through full ownership disclosure. 138) On-Going Concern: - ANS The facility will continue to operate INDEFINITLEY 139) Consistency: - ANS The accounting reports will be prepared in the same way year to year to allow the facility to compare history to determine risks, and allow for clarity 140) Full Disclosure: - ANS All information must be shown in financial records accurately reflecting the financial standing of the facility 141) Cash Accounting: - ANS Expenses are recorded when cash disbursed and revenues are recorded when money received. (Recorded money as it flows in and out of facility. Similar to checkbook) A. Advantage: Simplicity B. Disadvantage: Does not recognize depreciation, accounts receivable, or payable 142) Time period: - ANS Accounting period (12 months) will be consistent year to year 143) Objective Evidence: - ANS Accounting records are prepared with documentable records kept by facility (Audit Trail) 144) Accrual Accounting: - ANS Revenues are recognized when they are earned and expenses when they are incurred, regardless of when cash transactions take place. A. Advantage: Measure revenues earnings after expenses incurred; include depreciation, AP and AR B. Disadvantage: Complexity 145) Chart of accounts: - ANS list of every account organized into: Assets, Liabilities, Capital, Revenue, Expenses 146) Assets: - ANS things the facility OWN 147) Liabilities: - ANS things the facility OWES 148) Capital: - ANS Net worth or fund balance 149) Revenues: - ANS Earnings 150) Expenses: - ANS cost of personnel and supplies used in provision of service 151) Journals: - ANS books of original entry (the first place transactions are recorded) Cash receipts, billing, accounts payable (purchases), cash disbursements, payroll, general. 152) General: - ANS non-repetitive entries. Used to make adjustments to conform to accrual system. 153) Double entry: - ANS two entries for each transaction DEBIT and CREDIT 154) General Ledger: - ANS summary of all debits and credits contained in all the journals for the time period. 1. Continuous balance for each account monthly 2. Basis for "trail balance" 156) Financial Statement: - ANS summary of all transactions made in a particular time period and their effect on the finances of the facility. 157) Handling Cash - ANS Two person procedure; one receives by opening mail or taking in person; the other prepares bank deposit 158) Collections - ANS policy for deliquent bills. MUST BE CONSISTENT with all payment types; in not facility could be charged with fraud. 159) Payroll - ANS largest expense (50-70% of operational) controlled by administration separate bank account 160) Residents' Accounts (Trust fund) - ANS Legally must provide Safe for cash and valuables Separate accounting Interest Bearing - amounts over $50.00 161) Cost Per Patient Day = - ANS Total cost/census days RESIDENT CARE & QUALITY OF LIFE (35% - 52 questions) - ANS 162) Nursing Assistant Training - ANS 75 hour course and exams plus continuing in service 164) Excess Disability - ANS Avoidable Dysfunction 165) PASAAR - ANS Insures appropriate treatment for MR/MI population 166) Function - ANS Focus of Rehab 167) Pharmacist - ANS Monthly drug review/Audits 168) Basis for Menu - ANS Basic 4 plus recommended daily allowances 168) Nursing Assistants - ANS Provide most direct care 169) OBRA ^87 - ANS Conditions to participate in Medicare and Medicaid 170) MDS - ANS Comprehensive Assessment within 14 days of admission 171) Physician Extenders - ANS Nurse Practitioner, Clinical Nurse Specialist or Physician Assistant 172) Licensed Nurse - ANS Charge Nurse on each tour of duty 173) Time between Super and Breakfast - ANS 14 hours 174) RN Coverage - ANS 8 consecutive hours, 7 days per week 175) Frequency of Activities - ANS 7 days per week during hours requested 176) Frequency of Doctor Visits - ANS Every 30 days for first 90 days, then every 60 days 177) Access to records - ANS 24 hours of request 178) Care Plans - ANS 21 days after admissions 179) Required in service for CENA - ANS 12 hours per year 180) QA meetings - ANS Quarterly 181) Work before NA certified - ANS 4 months 182) Interest Bearing accounts - ANS trust funds greater than $50 183) Involuntary Transfer Notice - ANS 30 days 184) CVA - ANS Stroke 185) COPD - ANS Emphysema, Asthma, Bronchitis 186) ac - ANS before meals 187) Meal service: - ANS Key to high resident morale. 3-5 meals per day with no more than 14 hours btw evening meal and next breakfast (16 if HS snack) 188) Dishwashing - ANS wash at 150 to 1600 degrees F 189) Hot food tray - ANS leave tray line above 140 degrees F 190) Cold food - ANS leave tray line at less than 41*F 191) Freezer - ANS 0* - 20* F 192) Refrigeration - ANS 32* - 45*F 193) Storage - ANS room temperature 194) RDA - ANS Recommended Daily Allowance Bread: 4 servings Fruit/veggies 2 cups Meat: 4 oz Milk: 2 cups 195) Quality Assurance Committe - ANS DON, a physician, and 3 other staff members A. Care plan B. Infection Control C. Pharmacy Committee D. Safety Committe 196) Administration - ANS A. License B. Compliance with standards and regulations C. Governing body D. Nurse Aide Training E. Medical Director F. Laboratory Services G. Radiology Service H. Clinical Services I. Disaster Plan J. Transfer Agreement K. Quality assurance L. Disclosure The most likely cause of for series of bankruptcies among larger nursing home chains around the year 2000 was - ANS Paying too much for acquisitions in 1998 and 1999 In a chance conversation with the owner of an eight-facility chain, the newly hired administrator for the oldest facility in the chainindicates that, since the mortgage ia fully retired, he will concentrate more on being effective then effecient since his Quality Indicators are all at or above his state's average. The owner would likely - ANS Be distressed Occupancy of Facility A has been a steady 70% since Prospective Payment System was introduced. Two weeks ago, a new 120-bed equally equipped facility opened several blocks away. The facility A administrator tells the admissions counselor to continue the usual recruitment approach. The chain owners ought to - ANS Seek a new administrator Bankruptsy among larger nursing home chains prior to 2000 - ANS Were highly unusual Under the Prospective Payment System, nursing facilities reimbursed costs - ANS Were never bundled In recent years Medicare has - ANS shifted more cost onto nursing facilities The nurse newly promoted to director of nurses (DON) insist on giving four RN hours of patient care each day on the Alzheimer's wing in the 175-bed facility. The administrator should - ANS Seek a new DON The applicant for the administrator position in a facility near a larger teaching hospital who insists that, if hired, as before with his rural facility, he would not let Medicare reimbursement policies affect his case mix - ANS Is out of touch The newly hired assistant to the administrator insists the organizational chart line btw his position and the Department of Nursing be a solid line. The administrator should - ANS Be forwarned The medical supplies provider tells the administrator of the facility that has not paid bills the past 3 months, but is now operating under bankruptcy juge's approved plan for restructuring, that no more deliveries will be made until past bills are fully paid. The medical supply provider - ANS does not understand how bankruptsy works An administrator who adopts the management-by-walking-around (MBWA) approach by walking through the facility and intently observing weekly has - ANS Failed to understand MBWA Management-by-walking-around (MBWA) - ANS style of business management which involves managers wandering around, in an unstructured manner, through the workplace(s), at random, to check with employees, or equipment, about the staus of ongoing work The nursing home administrator who, using the management-by-walking-around (MBWA) technique, succeeds in atually making appropriate corrections on the spot during his rounds - ANS Doesnt understand (MBWA) The applicant for administrator of the facility insist that he has succcessfuly used democrate leadership to the exclusion of all other leadership styles. The intervier should - ANS continue to interview candidates The candidate for administrator said she used a variety of administrative styles, but could't say exactly which she would use in every circumstance. The interviewer should be - ANS favorable impress The candidate for administrator indicated that she consistently choose the charismatic style of leadership. This should __________the interviewer. - ANS Alert The cost of providing subacute care to nursing home residents _________ - ANS Is perhaps triple that of more typical patient The nurse supervisor who had just been appointed DON announced at the first department head meeting that she had circulated a memo among the nurses that only formal communications were to be allowed in the nursing department. The administrator should - ANS Anticipate problems The department head was not surprised to learn that the employee had only heard his positive comments to the employee and ignored his criticism. The department head's grasp of the communicationn process is - ANS Appropriate The administrator routinely accepted as his nearly exclusive information source the director of nursing's positive reports on how nursing was going well. The administrator is - ANS Placing him at risk Periodic shortage of nurses available for nursing home employment _________ - ANS Is likely to remain for the foreseeable future Congress and the Federal rule makers behave as if the facility will run successfully if congress and CMS can write enough rules. They are - ANS Incorrect When the administrator notices the DON seeks to turn many duties as possible over to housekeeping, the administrator should conclude that the DON is - ANS Behaving normally The administrator insist that a timely copy of all reports generated within the facility come across her desk before anyone signs them. The administrator is _______ - ANS Not rationalizing her managemnt information system The administrator notices that incident reports are being insufficiently filled out, but does nothing, believing that the situation will likely correct itself. The administrator is ______ - ANS Failing to control effectively Corporate sends a directive its flagship facility administrator, directing the administrator's attention more towards outcome of resident care than cost of resident care during the coming 12 months. Corporate is more concerned with __________than with _________. - ANS Effectiveness/efficiency The long term care sector receiving increased funding and attention from the federal government is the ________________. - ANS Home health care sector The concept that nursing homes should be reimbursed by states for their actual costs was part of the _______ - ANS Hatch Amendment The intense health care cost-shifting efforts among providers such as Medicare, Medicaid and local governments is _____________ - ANS Likely to continue Worried about the level of actual resident care being achieved in the facility, the administrator directs the nurses to spend less time charting and more time focusing on the effeciveness of care being given to residents. The likely result will be ________ - ANS Better resident care, possible increase in deficiency citations The new social worker informs the head of nursing that admissions is all she has time for and that nursing must monitor and document each resident's socipsychological experience. - ANS Responding appropriately to priorities Attempting to find the right person for each well-defined job is known as the management function of __________ - ANS The administrator who takes steps that insure the goals are accomplished and that each job is done as planned is successfully ______________ - ANS Controlling quality The administrators' job is to assure that the ________employees do the tasks of the organization at an acceptable quality level. - ANS Appropriate The administrator who conducts a national search for a director of nursing position and interviews 20 candidates from 7 different surrounding states by phone is engaged in the managerial function of ______ - ANS Staffing Corporate sends a directiveto its flagship facility administrator, directing the administrator's attention more towards outcome of resident care than cost of resudent care during the coming 12 months. Corporate is more concerned with ______than with _____. - ANS Effectiveness/efficiency The long-term care receiving increased funding and attention from the federal government is the _______. - ANS Home health care sector The concept that nursing homes should be reimbursed by states for their actual cost was part of the _____. - ANS Hatch Amendment The intense health care costshifting efforts among providers such as Medicare, Medicaid, and local governments is ____. - ANS Likely to continue Worried about the level of actual resident care achieved in the facility, the administrator directs the nurse to spend less time charting and more time focusing on the effectiveness of care being given to the residents. The likely result will be___ - ANS Better resident care, but increased deficiency citatons The new social worker informs the head of nursing that the admissions is all she has time for and that nursing must monitor and document each resident's socipsychological experiences. The new social worker is _____ - ANS Responding appropriately to prorities Attempting to find the right person for each well-defined job is known as the managementfunction ______ - ANS Staffing The administrator who takes steps that assures the goals are accomplished and that each job as planned is successful __ - ANS Controlling quality The administrator's job is to assure that the ____employees do the task of the organization at an acceptable quality level. - ANS Appropriate The administrator who conducts a national serch for a director of nursing position and interviews 20 candidates from 7 different surrounding states by phone is engaged inthe managerial function of ______ - ANS Staffing In the end, it can be said that the administrator's responsiblity to meet resident care needs and facility needs ae ______ - ANS Both are equal Superior performance depends on taking exceptional care of residents via superior service and _____ - ANS Constant innovations Superior performance for a nursing facility comes through __ - ANS Innovation in ways to serve residents The supeb nursingb facility is supurb by virtue of its ____ - ANS Success in serving the residents Answering the phones and resident call bells with common courtesy and doing things that work are examples of ______ - ANS A blind flash of the obvious Giving every employee the space to innovate at least a little; listening to residents and acting on their ideas; and wandering around with residents, staff, and suppliers are examples of the different-to-achieve ________ - ANS Common sense, obvious In a facility of 120 beds, the administrator ____personally performs each of the management tasks. - ANS Need not To assure that all the management tasks are successfully accomplished, the administrator of a 120-bed facility will typically divide management into _____ - ANS Three layers A licensed person responsible for formulating and enforcing policies that will be applied to an entire facility is thought of as a/an ____ - ANS Upper-level manager The staff member responsible for reporting to upper-level management and at the same time interacting significantly with several lower-level managers is the ______ - ANS Director of Nursing The staff person for whom both upward and downward communication skills are most neccessary is the ____ - ANS Director of nursing When the director of nursing makes an effective policy decision without consulting the administrator, that impacts all nursing personnel, the administrator should ______ - ANS Be pleased In the typical nursing facility, the decision-making process is _______ establishment of lower, middle, and upper levels of management. - ANS Noticeably more complicated than the simple Among the following positions the _____has no authority to make decisions for the facility. - ANS Assitant to the Administrator Decisions made by persons on the staff to whom the administrator has deligated line authority are, in the final analysis, regaurded as decisions by ______. - ANS The administrator When a nurse practitioner, who is more highly qualified than the director of nursing, gives orders in the hallways, the director of nursing should feel _______ - ANS Undermined In times of crisis, corporate representatives, who hold a staff or advisory relationship to their counterparts in the local facility, may expect that their advice as staff be _________ - ANS Acted on as carrying line authority As a generalization, it can be asserted that management success belongs to those who ____ - ANS success prepared for the future Nursing home administrators should anticipate and successfully prepare for ______ -