NORTH CAROLINA NURSING HOME ADMINISTRATOR STATE EXAM 100% CORRECTLY ANSWERED QUESTIONS

NORTH CAROLINA NURSING HOME ADMINISTRATOR STATE EXAM 100% CORRECTLY ANSWERED QUESTIONS ""Brain injury long term care" definition - CORRECT ANSWER an interdisciplinary, intensive maintenance program for patients who have incurred brain damage caused by external physical trauma and who have completed a primary course of rehabilitative treatment and have reached a point of no gain or progress for more than three consecutive months. Provided through a medically supervised interdisciplinary process and is directed toward maintaining the individual at the optimal level of physical, cognitive, and behavioral functions" "Capacity definition - CORRECT ANSWER the maximum number of patient or resident beds for which the facility is licensed to maintain at any given time" ""Comprehensive, inpatient rehabilitation program" definition - CORRECT ANSWER program for the treatment of persons with functional limitations or chronic disabling conditions who have the potential to achieve a significant improvement in activities of daily living, including bathing, dressing, grooming, transferring, eating, and using speech, language, or other communication systems. Utilizes a coordinated and integrated, interdisciplinary approach, directed by a physician, to assess patient needs and to provide treatment and evaluation of physical, psychosocial, and cognitive deficits." # of errors / # of opportunities for error x 100 ex: 5 errors / 60 opportunities = 0.083 x 100 = 8.3%" ""Misappropriation of property" definition - CORRECT ANSWER the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a patient's belongings or money without the patient's consent" "Neglect definition - CORRECT ANSWER a failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness" ""New facility" meaning - CORRECT ANSWER a facility for which an initial license is sought, a proposed addition to an existing facility, or a proposed remodeled portion of an existing facility that will be built according to construction documents and specifications approved by the Department of Health and Human Services for compliance which standards established in this Subchapter [13D]" ""Nurse aide" definition - CORRECT ANSWER a person who is listed on the NC Nurse Aide Registry and provides nursing or nursing-related services to patients in a nursing home. A nurse aide is not a licensed health professional." "Patient definition - CORRECT ANSWER any person admitted for nursing care" "Resident definition - CORRECT ANSWER any person admitted for care to an adult care home part of a combination facility" ""Respite care" definition - CORRECT ANSWER services provided for a patient on a temporary basis, not to exceed 30 days" "New facility licensure application requirements - CORRECT ANSWER A legal entity shall submit an application for licensure for a new facility to the Nursing Home Licensure and Certification Section of the DHSR at least 30 days prior to a license being issued or patients admitted. Application must include: - legal identity of applicant (licensee) and mailing address - name(s) under which the facility is presented to the public - location and mailing address of the facility - ownership disclosure - bed complement - magnitude and scope of services offered - name and current license number of the administrator - name and current license number of the DON - name and current license number of the medical director" "(T/F) Only one license shall be issued to each facility. - CORRECT ANSWER True" "(T/F) Licenses are transferable - CORRECT ANSWER False - licenses are not transferable" "Where should the license be posted? - CORRECT ANSWER In a prominent location, accessible to public view, within licensed premises" "Licenses shall remain in effect for ________ - CORRECT ANSWER 12 months" "Licenses shall remain in effect for 12 months, unless ________ - CORRECT ANSWER - Department imposes an administrative sanction which specifies license expiration; - change of ownership; - change of site; - change in bed; complement; or - failure to comply with Rule .2104 of this Section" "The Department shall renew the facility's license at the end of each _____________ - CORRECT ANSWER calendar year" "Requirements for facility license renewal - CORRECT ANSWER - licensee maintains and submits to the Department, at least 30 days prior to the licensure expiration date, statistical data for the State's medical facilities plan and review for certificate of need determination - the facility is in conformance with G.S. 131E-102(c) - the combination facility shall specify on the annual license renewal application with which rules for the adult care home beds it plans to comply for the upcoming calendar year. The facility may choose one of the following: (a) nursing home licensure rules under this Subchapter [13D] (b) adult care home licensure rules under 10A NCAC 13F; or (c) a combination of nursing hoe and adult care home licensure rules. The facility shall identify in writing a specific rule governing compliance with the nursing home rules." "The facility shall notify the Nursing Home Licensure and Certification Section of the DHSR in writing and make changes in the licensure application ________ prior to the occurrence of: - a change in the name(s) under which the facility is presented to the public - a change in the legal identity (licensee) which has ownership responsibility and liability (such information shall be submitted by the proposed new owner) - a change in the licensed bed capacity - a change in the location of the facility **the Department shall issue a new license following notification and verification of data submitted - CORRECT ANSWER at least 30 days" "The facility shall notify the Nursing Home Licensure and Certification Section of the DHSR within _______ following the occurrence of: - change in administration - change in the DON - change in facility mailing address or telephone number - changes in the magnitude or scope of services - emergencies or situations requiring relocation of patients to a temporary location away from the facility - CORRECT ANSWER one working day" "The Division shall authorize, in writing, a temporary increase in licensed bed in accordance with rules, if it is determined that: (1) the increase is not associated with _____; and (2) the increase would not _____ - CORRECT ANSWER capital expenditure jeopardize the health, safety, and welfare of the patients" "The Department may amend a license by reducing it from a full license to a provisional license whenever the Department finds that: 1) the licensee has substantially failed to comply with the provisions of G.S. 131E, Article 6 and the rules promulgated under that article; and 2) there is continued non-compliance after ______ - CORRECT ANSWER the third revisit" "The Department shall give the licensee written notice of the amendment to the license. This shall be given personally or by certified mail and shall set forth: 1) the length of the ____ license 2) a reference to the ____ that contains the facts 3) the ____ alleged to be violated; and 4) notice of the facility's right to a ____ on the amendment of the license - CORRECT ANSWER 1) provisional 2) statement of deficiencies 3) statutes or rules 4) contested case hearing" "The issuance of a provisional license (IS / IS NOT) a procedural prerequisite to the revocation of a license pursuant to Paragraph (e) of this Rule. - CORRECT ANSWER is not" "The Department may, in accordance with G.S. 131E-232, petition to have a _____ appointed to operate a facility - CORRECT ANSWER temporary manager" "The Department shall notify the facility personally or by certified mail of the decision to suspend admissions. Such notice shall include: 1) a reference to the ____ that contains the facts; 2) citation of ____ alleged to be violated; and 3) notice of the facility's right to ____ on the suspension - CORRECT ANSWER 1) statement of deficiencies 2) statutes and rules 3) a contested case hearing" "(T/F) The facility shall admit new patients during the effective period of the suspension - CORRECT ANSWER False - the facility shall not admit new patients" "The suspension is effective on the date specified in the _____ - CORRECT ANSWER notice of suspension" "The suspension shall remain effective until the facility demonstrated to the Department: - CORRECT ANSWER that conditions are no longer detrimental to the health and safety of the patients" "(T/F) Patients requiring hospitalization during the period of suspension of admissions shall be readmitted after hospitalization or on return from temporary care to the facility based on the availability of a bed and the ability of the facility to provide necessary care - CORRECT ANSWER True" "(T/F) The facility may admit new patients during the effective suspension period - CORRECT ANSWER False" "(T/F) The facility may appeal any decision of the Department to deny, revoke, or alter a license or any decision to suspend admissions - CORRECT ANSWER True" "(T/F) A decision to issue a provisional license is stayed during the pendency of an administrative appeal and the licensee may continue to display full license during the appeal - CORRECT ANSWER True" "The facility shall allow inspection by an authorized representative of the Department at _____ - CORRECT ANSWER any time" "(T/F) At the time of inspection, authorized representatives of the Department are not required to make their presence known to the administrator or other person in charge - CORRECT ANSWER False Any authorized representative of the Department shall make his/her presence known to the administrator or other person in charge" "A facility shall be under the control of the administrator licensed by _____ - CORRECT ANSWER The North Carolina Board of Examiners for Nursing Home Administrators" "If an administrator is not the sole owner of the facility, his/her authority and responsibility shall be defined in a written agreement or in the facility's _____ - CORRECT ANSWER governing bylaws" "The ____ shall be responsible for the operation of a facility. - CORRECT ANSWER administrator" "The administrator shall comply with the rules of Subchapter ____ - CORRECT ANSWER 13D" "(T/F) The administrator shall be responsible for developing and implementing policies for the management and operation of the facility - CORRECT ANSWER True - as set forth in 21 NCAC 37B .0204, which is incorporated herein by reference including subsequent amendments and editions. These rules may be accessed free of charge at "In the physical absence of the administrator, a person shall be ____ who is designated to be in charge of the facility operation. - CORRECT ANSWER on-site" "No patient shall be admitted except by a ____ - CORRECT ANSWER physician" "Admission shall be in accordance with ____ policies and procedures - CORRECT ANSWER facility" "When shall the facility acquire orders for immediate care of the patient from the admitting physician? - CORRECT ANSWER prior to or at the time of admission" "When shall the facility shall acquire medical information which shall include current medical information (e.g., medical findings, diagnoses, and other information necessary to formalize the initial plan of care)? - CORRECT ANSWER within 48 hours of admission" "Only persons who are ____ years or older shall be admitted to the adult care home portion of a combination facility. - CORRECT ANSWER 18" "(T/F) Patients who require health, habilitative or rehabilitative care beyond those for which the facility is licensed and capable of providing shall not be admitted to the licensed nursing home. - CORRECT ANSWER True" "(T/F) Persons requiring continuous nursing care shall be admitted into an adult care home bed in a combination facility. - CORRECT ANSWER False No person requiring continuous nursing care shall be admitted to an adult care home bed in a combination facility, except under emergency situations as described in Rule .2105 of this Subchapter. Should an existing resident of an adult care home bed require continuous nursing care, the facility shall either discharge the resident or provide the next available nursing facility bed (that is not needed to comply with G.S. 131E-130) to the resident to ensure continuity of care and to prevent unnecessary discharge from the facility" "(T/F) Respite care is required as a condition of licensure. - CORRECT ANSWER False Respite care is not required as a condition of licensure. Facilities providing respite care, however, shall meet the requirements of this Subchapter [13D] with the following exceptions: Rules .2205, .2301, and .2501(b) and (c) of this Subchapter." "A respite patient's descriptive record shall include: - CORRECT ANSWER 1) preadmission or admission assessment 2) IDT notes as warranted by episodic events 3) medication administration records 4) a summary of the stay upon discharge" "(T/F) The facility shall complete a preadmission or admission assessment which allows for the development of a short-term plan of care and is based on the respite patient's customary care. - CORRECT ANSWER True The assessment shall address needs, including but not limited to identifying information, customary routines, hearing, vision, cognitive ability, functional limitations, continence, special procedures and treatments, skin conditions, behavior and mood, oral and nutritional status and medication regimen. The plan shall be developed to meet the respite care patient's needs." "(T/F) The facility must ensure a medical order for discharge (except when a patient leaves against medical advice or is discharged for non-payment). - CORRECT ANSWER True" "(T/F) The patient or the legal representative must be informed and included in the discharge planning process. - CORRECT ANSWER True" "Who is responsible for the implementation of patient care policies and coordination of medical care in the facility? A) administrator B) director of nursing C) medical director D) attending physician - CORRECT ANSWER C) medical director" "Who shall designate a physician to serve as medical director? A) administrator B) the facility C) the governing board D) director of nursing - CORRECT ANSWER B) the facility" "(T/F) The facility shall enforce the Nursing Facility Patient's Bill of Rights. - CORRECT ANSWER True" "The facility shall provide training for all employees in emergency procedures upon employment and _____. - CORRECT ANSWER annually" "The facility shall have detailed written plans and procedures to meet potential emergencies and disasters, including but not limited to: 1) 2) 3) - CORRECT ANSWER 1) fire 2) severe weather 3) missing patients or residents" "(T/F) The facility shall conduct announced drills using the emergency procedures. - CORRECT ANSWER False unannounced" "The facility shall ensure that: - the patient's environment remains free of ____ as possible; and - each patient receives adequate supervision and assistance to prevent accidents - CORRECT ANSWER accident hazards" "The facility shall maintain records of infections and of the ____ taken. - CORRECT ANSWER corrective actions" "(T/F) Tuberculosis screening shall be done upon admission of ALL patients being admitted from settings other than hospitals, nursing facilities, or combination facilities. - CORRECT ANSWER True" "Staff should be screened for tuberculosis within ____ of the hire date. - CORRECT ANSWER 7 days" "Following initial admission/hire tuberculosis screening, the facility shall ensure screening ____ for patients and staff. - CORRECT ANSWER annually" "(T/F) An employee with a communicable disease or infected skin lesion, in which direct contact is the mode of transmission of disease, may engage in direct contact with patients or their food as long as they wear PPE. - CORRECT ANSWER False The facility shall prohibit any employee with a communicable disease or infected skin lesion from direct contact with patients or their food, if direct contact is the mode of transmission of the disease." "All linen shall be handled, stored, processed, and transported so as to prevent ____. - CORRECT ANSWER the spread of infection" "Two measures to prevent patient abuse, patient neglect, or misappropriation of patient property: 1) 2) - CORRECT ANSWER 1) orientation and instruction of facility staff on patients' rights 2) the screening of and requesting of references for all prospective employees" "A facility shall ensure that the Division of Health Service Regulation (DHSR) is notified within ____ of the facility's becoming aware of any allegation against health care personnel of any act listed in G.S. 131E-256(a)(1). - CORRECT ANSWER 24 hours" "Three things the facility shall do while an allegation investigation is in progress: 1) 2) 3) - CORRECT ANSWER 1) investigate allegation 2) document all information pertaining to such investigation 2) take the necessary steps to prevent further incidents" "A facility shall ensure that the report of investigation is printed or typed and sent to DHSR within ____ of the allegation. - CORRECT ANSWER 5 working days" "5-working day report of allegation investigation includes: 1) 2) 3) 4) 5) 6) 7) - CORRECT ANSWER 1) the date and time of the alleged incident 2) the patient's full name and room number 3) details of the allegation and any injury 4) names of the accused and any witnesses 5) names of the facility staff who investigated the allegation 6) results of the investigation 7) any corrective action that was taken by the facility" "Professional staff shall be licensed, certified, or registered in accordance with applicable ____ laws. - CORRECT ANSWER state" "The facility shall provide orientation regarding facility ____ and ____ for all staff upon employment. - CORRECT ANSWER policies and procedures" "The facility shall train all staff ____ in accordance with their job duties. - CORRECT ANSWER periodically" "(T/F) Verification of credentials shall be maintained in each employee's individual personnel record. - CORRECT ANSWER True" "(T/F) The facility is not required to orient agency staff to facility policies and procedures. - CORRECT ANSWER False" "(T/F) The facility must have a written agreement with any nursing personnel agency providing staff to the facility. - CORRECT ANSWER True" "(T/F) The medical director must be included in the quality assessment and assurance committee. - CORRECT ANSWER False" "(T/F) A pharmacist must be included in the quality assessment and assurance committee. - CORRECT ANSWER True" "Who establishes the QA committee? - CORRECT ANSWER The administrator" "The QA committee shall meet at least ____. - CORRECT ANSWER quarterly" "(T/F) A comprehensive assessment may only be coordinated by an LPN or RN. - CORRECT ANSWER False The comprehensive assessment shall be coordinated by an RN." "13 components included in a comprehensive assessment: - CORRECT ANSWER 1) current medical diagnoses 2) medical status measurements (e.g., current cognitive status; vitals; abnormal lab values and diagnostics that are part of the medical history) 3) pt's ability to perform ADLs (including need for staff assistance and assistive devices and the patient's ability to make decisions) 4) presence of neurological or muscular deficits 5) nutritional status measurements and requirements (e.g., height, weight, labs, eating habits and preferences, restrictions) 6) special care needs (e.g., pressure sores, enteral feedings, specialized rehab or respiratory care) 7) indicators of special needs related to pt behavior or mood, interpersonal relationships and other psychosocial needs 8) facility's expectation of discharging the pt within 3 months of admission 9) condition of teeth and gums, need and use of dentures or other dental appliances 10) pt's ability and desire to take part in activities (including assessment of pt's normal routine and lifetime preferences) 11) pt's ability to improve in functional abilities through restorative care 12) presence of visual, hearing, or other sensory deficits 13) drug therapy" "(T/F) The physician may participate in the preparation of the comprehensive plan of care via telephone or written notice. - CORRECT ANSWER True" "The facility shall review the comprehensive assessments and plans of care no less frequently than ____ and make necessary revisions to ensure accuracy. - CORRECT ANSWER once every 90 days" "(T/F) The DON must serve on a full-time basis. - CORRECT ANSWER True" "(T/F) The DON must be an RN. - CORRECT ANSWER True" "The facility shall provide licensed nursing staff sufficient to accomplish the following 3 components: - CORRECT ANSWER 1) patient needs assessments 2) patient care planning 3) supervisory functions in accordance with the levels of patient care advertised/offered by the facility" "The facility must have sufficient nursing and related services to attain/maintain the ____, ____, and ____ well-being of each patient, as determined by patient assessments and individual plans of care. - CORRECT ANSWER physical, mental, and psychosocial" "A multi-storied facility shall have at least ___ nurse aide(s) on duty on each patient floor at all times. - CORRECT ANSWER 1" "(Except for designated units with higher staffing requirements noted elsewhere in this Subchapter), Daily direct patient care nursing staff, licensed and unlicensed, must include at least ___ licensed nurse(s) for direct patient care at all times. - CORRECT ANSWER 1" "(Except for designated units with higher staffing requirements noted elsewhere in this Subchapter), Daily direct patient care nursing staff, licensed and unlicensed, must include a registered nurse at least ____ consecutive hours a day, ____ days a week. - CORRECT ANSWER 8 consecutive hours, seven days a week. This coverage may be spread over more than one shift if such need exits." "The DON may be counted as meeting the requirements for both the DON and patient staffing for facilities with a total census of ____ nursing beds or less. - CORRECT ANSWER 60" "The facility shall provide to the Department, upon request, verification of ____ and of past or present ___ of any nurse aide employed by the facility. - CORRECT ANSWER in-service training; employment" "The facility shall provide necessary care and services in accordance with ____, the patient's comprehensive assessment, and on-going plan of care. - CORRECT ANSWER medical orders" "(T/F) Acute changes in the patient's physical, mental, or psychosocial status shall be evaluated and reported to the physician or other persons legally authorized to perform medical acts. - CORRECT ANSWER True" "The facility shall not utilize any ____ for the purpose of discipline or convenience, and that are not required to treat the patient's medical condition. - CORRECT ANSWER chemical or physical restraints" "(T/F) An evaluation must be done to ensure that the least restrictive means of restraint have been initiated on patients requiring restraints. - CORRECT ANSWER True" "The facility shall ensure that all patients who are unable to perform ADLs receive the necessary assistance to maintain good ____, ____, and ____ hygiene. - CORRECT ANSWER grooming; oral; personal" "The facility shall ensure appropriate measures are taken to restore the patient's ability to: 1) 2) 3) 4) 5) 6) - CORRECT ANSWER 1) bathe 2) dress 3) groom 4) transfer and ambulate 5) toilet 6) eat" "The facility shall ensure patients with limited ROM, or who are at risk for loss of ROM, receive treatment services to prevent development of ____ or ____, and to obtain/maintain their optimal level of functioning. - CORRECT ANSWER contractures or deformities." "The facility shall ensure that patients who are unable to feed themselves receive the appropriate ____, ____, and ____ when needed. - CORRECT ANSWER assistance, retraining, and assistive devices" "(T/F) The facility shall ensure that enteral feeding tubes are used ONLY when the patient's condition indicated the use of an enteral feeding tube is unavoidable. - CORRECT ANSWER True" "The facility shall ensure that patients fed by enteral feeding tubes receive the proper treatment to avoid: - CORRECT ANSWER aspiration pneumonia, metabolic, and gastrointestinal problems" "(T/F) The facility is not responsible for ensuring that patients are assisted to utilize visual lenses, hearing aids, and dentures. - CORRECT ANSWER False" "(T/F) The facility is responsible for ensuring that patients requiring special respiratory care receive appropriate services. - CORRECT ANSWER True" "The facility shall ensure that medications are administered in accordance with applicable ____ licensure regulations and ____ recommendations. - CORRECT ANSWER occupational; manufacturer's" "Monitoring medication means ongoing collection and analysis of information (e.g., observations and diagnostic test results) and comparison of baseline data in order to: 1) Ascertain ____ 2) Detect ____ 3) Support ____ - CORRECT ANSWER 1) Ascertain the individual's response to treatment and care, including progress or lack of progress toward a therapeutic goal 2) Detect any complications or adverse consequences of the condition or of the treatments 3) Support decisions about modifying, discontinuing, or continuing any interventions" "Antipsychotic therapy shall not be initiated on any patient unless: - CORRECT ANSWER necessary to treat a clinically diagnosed and clinically documented condition" "(T/F) Gradual dose reductions and behavioral interventions, unless clinically contraindicated, are required to be employed in antipsychotic therapy. - CORRECT ANSWER True" ""Gradual dose reduction" meaning - CORRECT ANSWER The stepwise tapering of a dose to determine if symptoms, conditions, or risks can be managed by a lower dose or if the dose or the medication can be discontinued" "Signed medical orders for medications and drug treatments must include the following six items: - CORRECT ANSWER 1) drug name 2) strength 3) quantity to be administered 4) route of administration 5) frequency 6) if PRN, a stated indication for use" "(T/F) A patient may self-administer medication if the DON determines that this practice is safe. - CORRECT ANSWER False" "The four requirements for self-administration of medication include: - CORRECT ANSWER 1) determination by the IDT that this practice is safe 2) administration ordered by the physician or other person legally authorized to prescribe medications 3) instructions for administration printed on the medication label; and 4) administration of medication monitored by the nursing staff and consultant pharmacist." "(T/F) The administration of one patient's medications to another patient is prohibited under all circumstances. - CORRECT ANSWER False The administration of one patient's medications to another patient is prohibited except in the case of an emergency - in the event of such emergency, the facility shall ensure that the borrowed medications are replaced and so documented" "(T/F) Omission of medication and the reason for omission shall be indicated in the patient's medical record. - CORRECT ANSWER True" "Information included in medication administration records - CORRECT ANSWER 1) time of administration 2) identification of the drug 3) strength of drug 4) quantity of drug administered 5) route of administration 6) frequency 7) documentation sufficient to determine the staff who administered the drug 8) documentation of injection sites and topical medical sites requiring rotation of transdermal medication" "The ____ shall receive an exact copy of each physician's order for medications and treatments. - CORRECT ANSWER pharmacy" "When medication orders do not state the number of doses or days to administer the medication, the facility shall implement ____ according to the manufacturer's recommendations. - CORRECT ANSWER automatic stop orders" "The facility shall maintain a(n) ____ of controlled substances as defined by the NC Controlled Substances Act, G.S. 90, Article 5. - CORRECT ANSWER accountability" "The facility shall ensure that ____ and ____ dental services are available for all patients. - CORRECT ANSWER routine and emergency" "(T/F) The facility shall, if necessary, assist the patient in making appointments and transportation to the dentist's office. - CORRECT ANSWER True" "(T/F) In a combination home, the nurse-in-charge shall not also serve as supervisor-in-charge of the domiciliary beds. - CORRECT ANSWER False The nurse-in-charge of the nursing facility may also serve as supervisor-in-charge of the domiciliary beds" "(T/F) If adult care homes are located in a separate building or a separate level of the same building, there shall be a person on duty in the adult care home portion of the facility at all times. - CORRECT ANSWER True" "(T/F) Each state shall develop and implement a Cardio-Pulmonary Resuscitation (CPR) policy. - CORRECT ANSWER False Each facility shall develop and implement a Cardio-Pulmonary Resuscitation (CPR) policy." "(T/F) The CPR policy shall be communicated to all residents or their responsible party at the time of admission. - CORRECT ANSWER False The CPR policy shall be communicated to all residents or their responsible party prior to admission." "(T/F) Upon admission, each resident or his or her responsible party must verbally acknowledge that they have received a copy of the CPR policy. - CORRECT ANSWER False Upon admission, each resident or his or her responsible party must acknowledge in writing having received a copy of the CPR policy." "(T/F) The CPR policy shall designate an outside emergency medical service provider to be notified whenever an emergency occurs. - CORRECT ANSWER True" "(T/F) The facility shall maintain a record in the personnel file of each person who has received CPR training. - CORRECT ANSWER True" "The facility shall have equipment readily available as required to deliver services stated in the ____. - CORRECT ANSWER policy" "The facility shall ensure that a ____ is maintained, listing patients alphabetically by name, dates of admission, dates of discharge, and case number. - CORRECT ANSWER master patient index" "(T/F) The medical records manager, designated by the administrator, may work on a part-time basis if the building has less than 60 beds. - CORRECT ANSWER False The administrator shall designate an employee who works full-time to be the medical records manager" "If the medical records manager is not qualified by training or experience in medical record science, he or she shall receive consultation from a ____ or an ____ to ensure compliance with rules contained in this Subchapter. - CORRECT ANSWER registered records administrator; accredited medical record technician" "(T/F) The facility shall provide orientation, on-the-job training, and in-service programs for ALL medical records personnel. - CORRECT ANSWER True" "A facility shall keep medical records on file for ____ following the discharge of an adult patient. - CORRECT ANSWER 5 years" "Excluding the scenario of a facility discontinuing operation, if a patient is a minor when discharged from the nursing facility, the records shall be kept on file ____ and for the additional time specified in G.S. 1-17(b) for commencement of an action on behalf of a minor. - CORRECT ANSWER until his or her 19th birthday" "If a facility discontinues operation, the licensee shall inform ____ where its records are stored. - CORRECT ANSWER DHSR" "For ____ after a facility discontinues operations, records shall be stored with a business offering medical record storage and retrieval services. - CORRECT ANSWER 5 years" "All medical records are confidential. A facility shall comply with 42 CFR Parts 160, 162, and 164 of the ____. - CORRECT ANSWER Health Insurance Portability and Accountability Act (HIPAA)" "(T/F) A patient may deny DHSR access to his or her medical record. - CORRECT ANSWER True At the time of the inspection, a facility shall inform the surveyor of the name of any patient who has denied the Department access to his or her medical record pursuant to G.S. 131E-105" "The names and telephone numbers of the designated physicians shall be posted ____. - CORRECT ANSWER at each nurse's station" "(T/F) The facility shall ensure each patient's care is supervised by a physician and that provisions are made for emergency physicians when medical directors are unavailable. - CORRECT ANSWER False The facility shall ensure each patient's care is supervised by a physician and that provisions are made for emergency physicians when attending physicians are unavailable" "Patients shall be seen by a physician at least once every ____ for the first ____ and at least every ___ thereafter. - CORRECT ANSWER 30 days; 90 days; 60 days" "(T/F) Following the initial visit, the physician may delegate this responsibility to a physician assistant or nurse practitioner every other visit. - CORRECT ANSWER True" "A physician's visit is considered timely if it occurs not later than ____ after the visit was required. - CORRECT ANSWER 10 days" "(T/F) Medical orders may be given orally by the physician, nurse practitioner, or physician assistant. - CORRECT ANSWER True" "Medical orders, given orally by the physician, nurse practitioner, or physician assistant, shall be given only to a(n) ____ or other licensed professional who by law is allowed to accept physician orders, except for orders for therapeutic diets, which shall be given to either a(n) ____ or ____. - CORRECT ANSWER licensed nurse; dietician; licensed nurse" "The record of each telephone order shall include: 1) 2) 3) 4) - CORRECT ANSWER 1) the name of the physician giving the order, of other personal legally authorized to prescribe 2) date and time of the order 3) content of the order 4) name of person receiving the order" "The physician, or other personal legally authorized to prescribe, who gives oral orders shall sign the orders within ____. - CORRECT ANSWER 5 days" "(T/F) Each patient or legal representative shall be allowed to select his or her private physician except in those facilities affiliated with medical teaching programs and having written policies requiring all patients to participate in the medical teaching program. - CORRECT ANSWER True" "(T/F) The private physician shall fulfill given requirements as determined by applicable state and federal regulations, and the facility's policies and procedures pertaining to physician services. - CORRECT ANSWER True" "The privileges of the NP or PA shall be defined in the ____, and shall be limited to those privileges authorized in 21 NCAC 36 .0802 and .0809 for the NP or 21 NCAC 32S .0212 for the PA. - CORRECT ANSWER facility's policies and procedures" "The facility shall provide or obtain clinical laboratory and radiology services to ensure that each patient's needs are met. Such services shall include the following: 1) provision of laboratory and radiology services within the facility or by ____; (2) diagnostic testing to be done only in accordance with a ____; (3) reports to be ____ once filed in the patient's medical record; (4) notification of the ____, ____ or ____ regarding findings; and (5) assistance in ____ for the patient when testing must be done other than in the facility - CORRECT ANSWER 1) contractual agreement 2) medical order 3) dated 4) physician, NP, or PA 5) arranging transportation" "For patients located in designated brain injury long-term care units, if a ____ or physician of equivalent experience is not available on a ___ basis to the facility, the facility shall provide for weekly medical management of the patient by another physician. In addition, oversight for the patient's interdisciplinary, long-term care program shall be provided by a qualified consultant physician who visits the patient ____, makes recommendations for and approves the interdisciplinary care plan, and provides consultation as requested to the physician who is managing the patient on a weekly basis. - CORRECT ANSWER physiatrist; weekly; monthly" "For patients located in designated brain injury long-term care units, the attending physician shall actively participate in individual case conference or care planning sessions and shall review and sign discharge summaries and records within ____ of a patient discharge. hen patients are to be discharged to either another health care facility or a residential setting, the attending physician shall ensure that the patient has been provided with a discharge plan which incorporates optimum utilization of community resources and post discharge continuity of care and services. - CORRECT ANSWER 15 days" "The facility shall provide pharmaceutical services under the supervision of a(n) ____, including procedures that ensure the accurate acquiring, receiving, and administering of all drugs and biologicals. - CORRECT ANSWER pharmacist" "The ____ shall be responsible for obtaining drugs, therapeutic nutrients and related products prescribed or ordered by a physician for patients in the facility. - CORRECT ANSWER facility" "To ensure that drug therapy is rational, safe and effective, a pharmaceutical care assessment shall be conducted in the facility at least every ____ for each patient. - CORRECT ANSWER 31 days" "All new admissions shall receive a pharmaceutical care assessment at the time of the pharmacist's next visit or within ____, whichever comes first. - CORRECT ANSWER 31 days" "The pharmaceutical care assessment shall include at least: 1) 2) - CORRECT ANSWER 1) a review of the patient's diagnoses, H&P, discharge summary, diet, vital signs, current physician's orders, laboratory values, progress notes, interdisciplinary care plans and medication administration records; and 2) the pharmacist's progress notes in the patient's medical record which reflect the results of this assessment and, if necessary, recommendations for change based on desired drug outcomes" "If the pharmacist is an employee of the facility and performs vending or clinical services, an up-to-date ____ and ____ shall be maintained. - CORRECT ANSWER job description; personnel file" "If pharmaceutical vending or clinical services are contracted, there shall be a current written agreement for each services which includes a(n) ____ for each party. - CORRECT ANSWER statement of responsibilities" "(T/F) The facility shall keep, or be able to make available, a copy of the current license of the pharmacists. - CORRECT ANSWER True" "The pharmacist shall report any potential drug therapy irregularities or discrepancies in drug accountability and administration with recommendations for change to the ____ and the ____. - CORRECT ANSWER DON; medical director" "Recommendations shall be communicated to the health care professionals in the facility who have the authority to effect a change. These reports shall be submitted ____ following the pharmacist's pharmaceutical care assessments. - CORRECT ANSWER monthly" "The ____ shall ensure documentation of action taken relative to the pharmacist's reports. A) DON B) administrator C) medical director D) attending physician - CORRECT ANSWER B) administrator" "The facility shall not possess a stock of prescription drugs for general or common use except as permitted by the North Carolina Board of Pharmacy and as follows: (1) for all ____ and ____ solutions in single unit quantities exceeding 49 ml. and related equipment for the use and administration of such; (2) ____ agents; (3) ____; (4) drugs designated for inclusion in ____ approved by the facility's Quality Assurance Committee; (5) ____ for injection; and (6) normal ____ for injection - CORRECT ANSWER (1) intravenous and irrigation (2) diagnostic (3) vaccines (4) an emergency kit (5) water (6) saline" "The contents of all prescriptions shall be kept in the ____ container bearing the ____ label as described in Subparagraph (b)(2) of this Rule. - CORRECT ANSWER original; original" "Except in a ____ or less unit dose system, each individual patient's prescription drugs shall be labeled with the following information: (1) the name of the ____ for whom the drug is intended; (2) the most recent date of ____; (3) the name of the ____; (4) the name and concentration of the drug, quantity dispensed, and prescription ____ number; (5) a statement of ____ which shall be indicated if a brand other than the brand prescribed is dispensed; (6) the ____ date, unless dispensed in a single unit or unit dose package; (7) ____ statements required of the drug; (8) the name, address, and telephone number of the dispensing ____; and (9) the name of the dispensing ____ - CORRECT ANSWER (1) patient (2) issue (3) prescriber (4) serial (5) generic equivalency (6) expiration (7) auxiliary (8) pharmacy (9) pharmacist" "Non-prescription drugs shall be kept in the original container as received from the supplier and shall be labeled with at least: (1) the name and ____ of the drug, and quantity packaged; and (2) the name of the manufacturer, ____ number, and expiration date - CORRECT ANSWER (1) concentration (2) lot" "A facility shall ensure that drug storage areas are clean, secure, well lighted and well ventilated; and that room temperature is between ____ and ____ degrees Fahrenheit. - CORRECT ANSWER 59 and 86 degrees F" "(T/F) All drugs shall be maintained under locked security except when under the direct physical supervision of a registered nurse or physician. - CORRECT ANSWER False All drugs shall be maintained under locked security except when under the direct physical supervision of a nurse or pharmacist." "Drugs requiring refrigeration shall be stored in a refrigerator containing a thermometer and capable of maintaining a temperature range of 2 to 8 degrees Celsius ( ____ to ____ degrees Fahrenheit). - CORRECT ANSWER 36 to 46 degrees F" "(T/F) Drug containers must be placed in a separate refrigerator than non-drug items. - CORRECT ANSWER False Drug containers must be placed in another container separate from non-drug items when stored in a refrigerator." "(T/F) Drugs intended for topical use, except for ophthalmic, otic, and transdermal medications, shall be stored in an area separate from the drugs intended for oral and injectable use. - CORRECT ANSWER True" "Drugs that are outdated, discontinued, or deteriorated shall be removed from the facility within ____. - CORRECT ANSWER 5 days" "The disposition of drugs shall be in accordance with written policies and procedures established by the ____. - CORRECT ANSWER Quality Assurance Committee" "Destruction of ____ substances shall be in compliance with Disposal of Unused ____ Substances From Nursing Home as described in 10A NCAC 26E .0406. - CORRECT ANSWER controlled; Controlled" "The facility shall ensure that accurate records of the receipt, use, and disposition of drugs are ____. - CORRECT ANSWER maintained and readily available" "A facility shall ensure ____ of controlled substances as defined by the Disposal of Unused Controlled Substances From Nursing Home as described in 10A NCAC 26E .0406. - CORRECT ANSWER accountability" "A facility shall maintain a supply of ____ drugs in compliance with 10A NCAC 26E .0408 - CORRECT ANSWER emergency" "(T/F) Emergency drugs shall be stored in a portable container sealed with a breakable closure which may be released or reused and shall be readily accessible for use. - CORRECT ANSWER False Emergency drugs shall be stored in a portable container sealed with an easily breakable closure which cannot be resealed or reused and shall be readily accessible for use." "Emergency drug kits shall be stored in a locked ____ or ____ out of sight of patients and the general public. - CORRECT ANSWER storage cabinet or room" "If stored in a locked area, the emergency drug kits shall be accessible to ____. - CORRECT ANSWER all licensed nursing personnel" "All emergency drugs and quantity to be maintained shall be approved by the ____ as defined in 10A NCAC 13D .2212. - CORRECT ANSWER Quality Assurance Committee" "(T/F) If emergency drug items require refrigerated storage, they shall be stored in a separate sealed container within the medication refrigerator. The container shall be labeled to indicate the emergency status of the enclosed drug. - CORRECT ANSWER True" "An accurate ____ of emergency drugs and supplies shall be maintained with each emergency drug kit. - CORRECT ANSWER inventory" "A facility shall examine the refrigerated and non-refrigerated emergency drug supply at least ____ and make any necessary changes at that time. - CORRECT ANSWER every 90 days" "The facility shall have ____ which are enforced to ensure that in the event the sealed emergency drug container is opened and contents utilized, steps are taken to replace the items used. - CORRECT ANSWER written policies and procedures" "The availability of a controlled substance in an emergency kit shall be in compliance with ____. - CORRECT ANSWER North Carolina Controlled Substances Act and Regulations (10A NCAC 26E)" "The facility shall ensure that each patient is provided with a ____ diet that meets his or her daily nutritional and specialized nutritional needs. - CORRECT ANSWER palatable" "The facility shall designate a person to be as known as the ____ who shall be responsible for the facility's dietetic service and for supervision of the dietetic service personnel. - CORRECT ANSWER director of food service" "Based on a resident's assessment, the nursing home must ensure that a patient maintains nutritional status, such as ____ and ____, unless the patient's clinical condition demonstrates that it is not possible. - CORRECT ANSWER body weight and protein levels" "There shall be sufficient personnel employed to meet the nutritional needs of all patients in the areas of ____ diets, food preparation and service, principles of sanitation, and resident's preferences as related to food services. - CORRECT ANSWER therapeutic" "The facility shall ensure that menus are followed which meet the nutritional needs of patients in accordance with the recommended dietary allowances of the: - CORRECT ANSWER Food and Nutrition Board of the National Research Council, National Academy of Sciences" "Menus shall be planned how far in advance? - CORRECT ANSWER At least 14 days" "Menus shall provide ____ of similar nutritive value for patients who refuse food that is served. - CORRECT ANSWER substitutes" "Menus shall be provided ____ or ____ through such methods as posting and daily announcements. - CORRECT ANSWER orally or written" "Food must be prepared to conserve its ____ and appearance. - CORRECT ANSWER nutritive value" "(T/F) Food shall be served at the preferred temperature as discerned by the resident and customary practice, in a form to meet the patient's individual needs and with assistive devices as dictated by the patient's needs. - CORRECT ANSWER True" "Hot foods shall leave the kitchen (or steam table) above ____ degrees F; and cold foods below ____ degrees F. - CORRECT ANSWER 135; 41" "(T/F) The freezer must keep frozen foods frozen solid. - CORRECT ANSWER True" "If patients require assistance in eating, food shall be maintained at what temperature until assistance is provided? - CORRECT ANSWER the appropriate temperature" "All diets, including ____ and ____ nutrition therapy, shall be ordered by the ____ or other legally authorized person, and served as ordered. - CORRECT ANSWER enteral and parenteral; physician" "(T/F) At least two meals shall be served daily to all patients in accordance with medical orders. - CORRECT ANSWER False at least three meals" "No more than ____ shall elapse between an evening meal containing a protein food and a morning meal containing a protein food. - CORRECT ANSWER 14 hours" "HS nourishment shall be available to patients upon request or in accordance with nutritional plans. What does HS mean? - CORRECT ANSWER hour-of-sleep" "Between-meal fluids for hydration shall be available to all patients in accordance with: - CORRECT ANSWER medical orders" "The facility shall have a current online or hard copy nutrition care manual or handbook approved by the ____, ____, and ____ which shall be used in the planning of the regular and therapeutic diets and be accessible to all staff. - CORRECT ANSWER dietician, medical staff, and administrator" "Food services shall comply with: - CORRECT ANSWER Rules Governing the Sanitation of Restaurants and Other Foodhandling Establishments Food services shall comply with Rules Governing the Sanitation of Restaurants and Other Foodhandling Establishments (15A NCAC 18A .1300) as promulgated by the Commission for Public Health which are incorporated by reference, including subsequent amendments, assuring storage, preparation, and serving of food under sanitary conditions." "The facility shall provide a program of activities that is on-going with the ____, and that promotes the interests as well as physical, mental, psychosocial well-being, of each. - CORRECT ANSWER comprehensive assessment" "The administrator shall designate an activities director who shall be responsible for activity and recreational services for all patients and who shall have appropriate ____ authority. - CORRECT ANSWER management" "Activities director qualifications: - CORRECT ANSWER (1) be a recreation therapist or be eligible for certification as a therapeutic recreation specialist by a recognized accrediting body; or (2) have two years of experience in a social or recreation program within the last five years, one of which was full-time in a patient activities program in a health care setting; or (3) be an occupational therapist or occupational therapy assistant; or (4) be certified by the National Certification Council for Activity Professionals; or (5) have completed an activities training course approved by the State" "The facility shall provide medically-related social services to attain or maintain the highest practicable ____, ____, and ____ well-being of each resident. - CORRECT ANSWER physical, mental, and psychosocial" "(T/F) The administrator shall designate an employee to be responsible full-time for social services. - CORRECT ANSWER True" "A facility with more than ____ nursing beds shall employ on a full-time basis a social worker. - CORRECT ANSWER 120" "Social worker qualifications: - CORRECT ANSWER 1) a Bachelors' degree in social work or a Bachelors' degree in human services field, including but not limited to sociology special education, rehabilitation counseling and psychology; and (2) one year of supervised social work experience in a health care setting working directly with patients." "The facility shall have a written plan to be followed in case of patient death. The plan shall provide for the following: (1) collection of data needed for the ____ (2) recording ____ of death (3) ____ of death in accordance with facility policy (4) notification of the ____ responsible for signing the death certificate (5) documented notification of ____ (6) authorization and release of the ____ to a funeral home - CORRECT ANSWER (1) death certificate (2) time (3) pronouncement (4) attending physician (5) next of kin or legal guardian (6) body" "When facility policies permit pets in the facility, the following conditions shall be met: - CORRECT ANSWER (1) The facility policy shall not be in violation of any local health ordinances regarding pet health and control (2) Pets shall not be permitted to enter areas where food is being prepared" "Facilities having patients who are ventilator assisted individuals shall provide pulmonary services from a ____ who has training in pulmonary medicine. - CORRECT ANSWER physician" "The physician shall be responsible for respiratory services and shall: (1) establish with the ____ and ____, ventilator policies and procedures, including emergency procedures; (2) assess each ventilator assisted patient's status at least ____ with corresponding progress notes; (3) respond to emergency communications ____ a day; and (4) participate in individual ____ - CORRECT ANSWER (1) respiratory therapist and nursing staff (2) monthly (3) 24 hours (4) care planning" "Direct care nursing personnel staffing ratios established in Rule .2303 of this Subchapter shall not be applied to nursing services for patients who are ventilator assisted at life support settings. The minimum direct care nursing staff shall be ____, allocated on a per shift basis as the facility chooses; however, in no event shall the direct care nursing staff fall below a registered nurse and a nurse aide I at any time during a 24-hour period. - CORRECT ANSWER 5.5 hours per patient day;" "Overall supervisory responsibility for brain injury long term care services shall be assigned to a ____ with one year experience in caring for brain injured patients. - CORRECT ANSWER registered nurse" "In brain injury long term care: Physical therapy shall be provided by a physical therapist with a current valid North Carolina license. Occupational therapy shall be provided by an occupational therapist with a current valid North Carolina License. The services of a physical therapist and occupational therapist shall be combined to provide one full-time equivalent position for each ____ patients. The assistance of a physical therapy aide and occupational therapy aide, with appropriate supervision, shall be combined to provide one full-time equivalent position for each ____ patients. A proportionate number of hours shall be provided for a census less than ____ patients. - CORRECT ANSWER 20; 20; 20" "In brain injury long term care: Clinical nutrition services shall be provided by a ____ with two years clinical training and experience in nutrition. The number of hours of clinical nutrition services on either a full-time or part-time employment or contract basis shall be adequate to meet the needs of the patients. Each patient's nutrition needs shall be reviewed ____. - CORRECT ANSWER dietician; at least monthly" "In brain injury long term care: Clinical nutrition services shall include: (1) Assessing the appropriateness of the ordered diet for conformance with each patient's physiological and pharmacological condition (2) Evaluating each patient's ____ data in relation to nutritional status and hydration (3) Applying technical knowledge of ____, ____, and equipment to each patient's specialized needs. - CORRECT ANSWER (2) laboratory (3) feeding tubes, pumps" "(T/F) In brain injury long term care, recreation therapy shall be provided on a full-time employment or contractual basis by a clinician eligible for certification as a therapeutic recreation specialist by the State of North Carolina Therapeutic Recreational Certification Board. - CORRECT ANSWER False Recreation therapy, when required, shall be provided on either a full-time or part-time employment or contract basis by a clinician eligible for certification as a therapeutic recreation specialist by the State of North Carolina Therapeutic Recreational Certification Board. The number of hours of therapeutic recreation services shall be adequate to meet the needs of the patients. In event that a qualified specialist is not locally available, alternate treatment modalities shall be developed by the occupational therapist and reviewed by the attending physician. The program designed shall be adequate to meet the needs of this specialized population and shall be administered in accordance with Section .3000 of this Subchapter." "In brain injury long term care: Each patient's program shall be governed by an interdisciplinary treatment plan incorporating and expanding upon the health plan required under Section .2300 of this Subchapter. The plan is to be initiated on ____. Upon completion of baseline data development and an integrated interdisciplinary assessment, the initial treatment plan is to be expanded and finalized within ____. - CORRECT ANSWER the first day of admission; 14 days of admission" "In brain injury long term care: Through an interdisciplinary process, the treatment plan shall be reviewed at least ____ and revised as appropriate. - CORRECT ANSWER monthly" "In brain injury long term care: In executing the treatment plan, the interdisciplinary team shall be the major decision making body and shall determine the goals, process, and time frames for accomplishment of each patient's program. Disciplines to be represented on the team shall be ____, ____, ____ and all other disciplines directly involved in the patient's treatment or treatment plan - CORRECT ANSWER medicine, nursing, clinical pharmacy" "(T/F) In brain injury long term care: Each patient's overall program shall be assigned to an individually designated case manager. The case manager acts as the coordinator for assigned patients. The case manager shall be a licensed social worker or professional with similar clinical background. - CORRECT ANSWER False Any professional staff member involved in a patient's care may be assigned this responsibility for one or more patients. Professional staff may divide this responsibility for all patients on the unit in the best manner to meet all patients' needs for a coordinated, interdisciplinary approach to care." "The brain injury long term care case manager is responsible for: - CORRECT ANSWER 1) coordinating the development, implementation and periodic review of the patient's treatment plan; (2) preparing a monthly summary of the patient's progress; (3) cultivating the patient's participation in the program; (4) general supervision of the patient during the course of treatment; (5) evaluating appropriateness of the treatment plan in relation to the attainment of stated goals; and (6) assuring that discharge decisions and arrangements for post discharge follow-up are properly made." "In brain injury long term care: For each 20 patients or fraction thereof, dedicated treatment facilities and equipment shall be provided as follows: (1) a combined therapy space equal to or exceeding ____, adequately equipped and arranged to support each of the therapies; (2) access to ____ full wheelchair(s) per patient; (3) special PT & OT equipment for use in fabricating positioning devices for beds and wheelchairs including ____, ____, ____, ____, and ____; and (4) roll-in bath facilities with a ____ area available to all patients, providing maximum privacy to the patient - CORRECT ANSWER (1) 600 square feet (2) one (3) splints, casts, cushions, wedges, and bolsters (4) dressing" "For patients who require brain injury long term care, the minimum direct care nursing staff shall be ____ per patient day, allocated on a per shift basis as the facility chooses, to appropriately meet the patients' needs. It is also required that regardless of how low the patient census, the direct care nursing staff shall not fall below a registered nurse and a nurse aide I at any given time during a ____ period. - CORRECT ANSWER 5.5 hours; 24-hour" "The minimum nursing house per spinal cord injury patient in the unit shall be ____ per patient day. At no time shall direct care nursing staff be less than ____ full-time equivalent(s), one of which shall be a registered nurse. - CORRECT ANSWER 6.0 nursing hours per day; two" "The inpatient rehabilitation facility or unit shall employ or provide by contractual agreements physical, occupational or speech therapists in order to provide a minimum of ____ of specific or combined rehabilitation therapy services per spinal cord injury patient day. - CORRECT ANSWER 4.0 hours" "(T/F) The facility shall provide special facility or special equipment needs of patients with spinal cord injury, including specially designed wheelchairs, tilt tables and standing tables. - CORRECT ANSWER True" "The medical director of an inpatient spinal cord injury program shall have either ____ experience in the medical care of persons with spinal cord injuries or ____ minimum in a spinal cord injury fellowship. - CORRECT ANSWER 2 years; 6 months" "(T/F) The facility shall provide continuing education in the care and treatment of spinal cord injury patients for nursing staff only. - CORRECT ANSWER False For all staff" "(T/F) The facility shall provide specific staff training and education in the care and treatment of spinal cord injury. - CORRECT ANSWER True" "What are the requirements regarding the size of the spinal cord injury program? - CORRECT ANSWER The size of the spinal cord i