SMQT CERTIFICATION ACTUAL
EXAM 2026/2027 | 150 Questions &
Verified Answers | Surveyor
Minimum Qualifications Test |
Comprehensive Practice Test | Pass
Guaranteed - A+ Graded
DOMAIN 1: CARE, TREATMENT, AND
SERVICES (40 Questions)
Question 1
A resident with advanced dementia repeatedly attempts to remove their gastrostomy tube.
The interdisciplinary team has tried multiple non-pharmacological interventions without
success. Which action represents the most appropriate next step?
A. Apply soft wrist restraints to prevent tube removal [CORRECT]
B. Administer PRN haloperidol to reduce agitation
C. Request a surgical consult for jejunostomy tube placement
D. Document the behavior and continue current interventions
Rationale: Physical restraints (Option A) may be used when less restrictive interventions have
failed and there is a documented medical symptom (risk of tube removal compromising
nutrition/hydration). Per CMS F604, restraints must be the least restrictive alternative, used
for the shortest duration, with a physician's order and care plan revision. Option B represents
a chemical restraint—antipsychotics should never be used for convenience or discipline.
Option C is premature without addressing the immediate safety issue. Option D is insufficient
given the immediate risk.
,CMS Note: F604 (Restraints) is frequently cited when facilities fail to document less
restrictive alternatives or use restraints for staff convenience rather than medical symptoms.
Question 2
During a quarterly care plan review, the interdisciplinary team notes a resident has
experienced 3 falls in 30 days. Which assessment tool is most appropriate to evaluate fall
risk factors?
A. Mini-Mental State Examination (MMSE)
B. Braden Scale for Predicting Pressure Sores
C. Morse Fall Scale or Hendrich II Fall Risk Model [CORRECT]
D. Geriatric Depression Scale (GDS)
Rationale: The Morse Fall Scale and Hendrich II Fall Risk Model (Option C) are validated tools
specifically designed to assess fall risk in long-term care populations. The MMSE (Option A)
assesses cognitive function. The Braden Scale (Option B) evaluates pressure ulcer risk. The
GDS (Option D) screens for depression. Per F689 (Accidents), facilities must identify
residents at risk for falls and implement preventive measures based on individualized
assessment.
Question 3
A resident's Braden Scale score has decreased from 18 to 12 over two weeks. Which
intervention takes priority?
A. Increase social activities to improve mood
B. Implement a turning/repositioning schedule every 2 hours [CORRECT]
C. Schedule a dental examination
D. Review the resident's advance directive
Rationale: A Braden score of 12 indicates high risk for pressure ulcer development (scores
≤18 indicate risk). Per F686 (Pressure Ulcers), the facility must ensure residents receive care
consistent with professional standards. Immediate implementation of a turning schedule
(Option B) addresses the primary physiological risk. While psychosocial needs (Option A) are
important, physiological safety takes priority. Options C and D are unrelated to pressure ulcer
prevention.
Question 4
,A resident with chronic pain refuses scheduled analgesic medication, stating "I don't want to
become addicted." Which response by the nurse demonstrates best practice?
A. "Don't worry—residents your age rarely become addicted to pain medication"
B. "If you don't take your medication, I'll need to notify your physician that you're
non-compliant"
C. "Let's discuss your concerns about addiction and explore non-pharmacological options as
well" [CORRECT]
D. "Your family wants you to take the medication, so you really should reconsider"
Rationale: Option C demonstrates person-centered care respecting resident autonomy (F552)
while addressing misconceptions about addiction versus physical dependence. The nurse
validates concerns, educates appropriately, and offers alternatives. Option A minimizes valid
concerns. Option B is coercive. Option D inappropriately involves family pressure without
resident consent.
Question 5
During medication administration, a nurse finds a resident's hydrocodone tablet on the floor
beside the bed. The resident states, "I dropped it and couldn't reach it." Which action must the
nurse take first?
A. Document the incident and notify the physician at the next scheduled visit
B. Dispose of the medication per facility policy and obtain a replacement dose [CORRECT]
C. Administer the medication from the floor since it appears clean
D. Return the medication to the pharmacy for credit
Rationale: Medications that leave the controlled environment or touch the floor must be
discarded per facility policy (Option B) due to contamination risk and potential for diversion.
The nurse must follow controlled substance documentation requirements and obtain a
replacement dose. Option A delays necessary action. Option C violates medication safety
standards. Option D is inappropriate for contaminated medications.
Question 6
A resident with severe COPD is receiving hospice care. The family requests that staff perform
CPR if the resident stops breathing. Which action aligns with regulatory requirements?
A. Honor the family's request as next-of-kin have decision-making authority
B. Review the resident's advance directive and hospice agreement, then facilitate a care
conference [CORRECT]
, C. Perform CPR regardless of documentation to avoid liability
D. Transfer the resident to the hospital immediately
Rationale: Option B follows F578 (Advance Directives) and hospice regulations. The facility
must verify existing advance directives and hospice election statements (which typically
include DNR provisions). A care conference addresses the family's misunderstanding while
respecting resident rights. Option A ignores the resident's prior expressed wishes. Option C
violates advance directive law. Option D is unnecessary without acute change.
Question 7
Which scenario represents a violation of resident rights per F550 (Resident Rights)?
A. A resident chooses to remain in bed instead of attending physical therapy
B. Staff enter a resident's room without knocking to deliver a meal tray
C. A resident with diabetes requests and receives a piece of birthday cake [CORRECT]
D. The interdisciplinary team schedules a care plan meeting without the resident present
Rationale: Option C represents a rights violation if staff denied the request based on
paternalistic concerns rather than resident choice. Per F552 (Self-Determination), competent
residents have the right to accept or refuse treatment, including dietary modifications. The
diabetes diagnosis does not automatically remove decision-making capacity. Options A, B,
and D describe appropriate situations (resident choice, minor courtesy issue, and team
planning respectively).
Question 8
A resident with Parkinson's disease exhibits increasing difficulty with activities of daily living.
Which intervention best supports functional independence?
A. Complete all ADLs for the resident to prevent fatigue
B. Provide adaptive equipment and allow extra time for self-care [CORRECT]
C. Restrict fluids to reduce toileting frequency
D. Transfer the resident to a locked unit for safety
Rationale: Option B aligns with F676 (Treatment/Services to Prevent/Heal Pressure Ulcers)
and rehabilitation principles. Adaptive equipment and time accommodations support dignity
and autonomy while maintaining function. Option A promotes dependence. Option C risks
dehydration and urinary complications. Option D is unnecessarily restrictive without
wandering or elopement risk.
EXAM 2026/2027 | 150 Questions &
Verified Answers | Surveyor
Minimum Qualifications Test |
Comprehensive Practice Test | Pass
Guaranteed - A+ Graded
DOMAIN 1: CARE, TREATMENT, AND
SERVICES (40 Questions)
Question 1
A resident with advanced dementia repeatedly attempts to remove their gastrostomy tube.
The interdisciplinary team has tried multiple non-pharmacological interventions without
success. Which action represents the most appropriate next step?
A. Apply soft wrist restraints to prevent tube removal [CORRECT]
B. Administer PRN haloperidol to reduce agitation
C. Request a surgical consult for jejunostomy tube placement
D. Document the behavior and continue current interventions
Rationale: Physical restraints (Option A) may be used when less restrictive interventions have
failed and there is a documented medical symptom (risk of tube removal compromising
nutrition/hydration). Per CMS F604, restraints must be the least restrictive alternative, used
for the shortest duration, with a physician's order and care plan revision. Option B represents
a chemical restraint—antipsychotics should never be used for convenience or discipline.
Option C is premature without addressing the immediate safety issue. Option D is insufficient
given the immediate risk.
,CMS Note: F604 (Restraints) is frequently cited when facilities fail to document less
restrictive alternatives or use restraints for staff convenience rather than medical symptoms.
Question 2
During a quarterly care plan review, the interdisciplinary team notes a resident has
experienced 3 falls in 30 days. Which assessment tool is most appropriate to evaluate fall
risk factors?
A. Mini-Mental State Examination (MMSE)
B. Braden Scale for Predicting Pressure Sores
C. Morse Fall Scale or Hendrich II Fall Risk Model [CORRECT]
D. Geriatric Depression Scale (GDS)
Rationale: The Morse Fall Scale and Hendrich II Fall Risk Model (Option C) are validated tools
specifically designed to assess fall risk in long-term care populations. The MMSE (Option A)
assesses cognitive function. The Braden Scale (Option B) evaluates pressure ulcer risk. The
GDS (Option D) screens for depression. Per F689 (Accidents), facilities must identify
residents at risk for falls and implement preventive measures based on individualized
assessment.
Question 3
A resident's Braden Scale score has decreased from 18 to 12 over two weeks. Which
intervention takes priority?
A. Increase social activities to improve mood
B. Implement a turning/repositioning schedule every 2 hours [CORRECT]
C. Schedule a dental examination
D. Review the resident's advance directive
Rationale: A Braden score of 12 indicates high risk for pressure ulcer development (scores
≤18 indicate risk). Per F686 (Pressure Ulcers), the facility must ensure residents receive care
consistent with professional standards. Immediate implementation of a turning schedule
(Option B) addresses the primary physiological risk. While psychosocial needs (Option A) are
important, physiological safety takes priority. Options C and D are unrelated to pressure ulcer
prevention.
Question 4
,A resident with chronic pain refuses scheduled analgesic medication, stating "I don't want to
become addicted." Which response by the nurse demonstrates best practice?
A. "Don't worry—residents your age rarely become addicted to pain medication"
B. "If you don't take your medication, I'll need to notify your physician that you're
non-compliant"
C. "Let's discuss your concerns about addiction and explore non-pharmacological options as
well" [CORRECT]
D. "Your family wants you to take the medication, so you really should reconsider"
Rationale: Option C demonstrates person-centered care respecting resident autonomy (F552)
while addressing misconceptions about addiction versus physical dependence. The nurse
validates concerns, educates appropriately, and offers alternatives. Option A minimizes valid
concerns. Option B is coercive. Option D inappropriately involves family pressure without
resident consent.
Question 5
During medication administration, a nurse finds a resident's hydrocodone tablet on the floor
beside the bed. The resident states, "I dropped it and couldn't reach it." Which action must the
nurse take first?
A. Document the incident and notify the physician at the next scheduled visit
B. Dispose of the medication per facility policy and obtain a replacement dose [CORRECT]
C. Administer the medication from the floor since it appears clean
D. Return the medication to the pharmacy for credit
Rationale: Medications that leave the controlled environment or touch the floor must be
discarded per facility policy (Option B) due to contamination risk and potential for diversion.
The nurse must follow controlled substance documentation requirements and obtain a
replacement dose. Option A delays necessary action. Option C violates medication safety
standards. Option D is inappropriate for contaminated medications.
Question 6
A resident with severe COPD is receiving hospice care. The family requests that staff perform
CPR if the resident stops breathing. Which action aligns with regulatory requirements?
A. Honor the family's request as next-of-kin have decision-making authority
B. Review the resident's advance directive and hospice agreement, then facilitate a care
conference [CORRECT]
, C. Perform CPR regardless of documentation to avoid liability
D. Transfer the resident to the hospital immediately
Rationale: Option B follows F578 (Advance Directives) and hospice regulations. The facility
must verify existing advance directives and hospice election statements (which typically
include DNR provisions). A care conference addresses the family's misunderstanding while
respecting resident rights. Option A ignores the resident's prior expressed wishes. Option C
violates advance directive law. Option D is unnecessary without acute change.
Question 7
Which scenario represents a violation of resident rights per F550 (Resident Rights)?
A. A resident chooses to remain in bed instead of attending physical therapy
B. Staff enter a resident's room without knocking to deliver a meal tray
C. A resident with diabetes requests and receives a piece of birthday cake [CORRECT]
D. The interdisciplinary team schedules a care plan meeting without the resident present
Rationale: Option C represents a rights violation if staff denied the request based on
paternalistic concerns rather than resident choice. Per F552 (Self-Determination), competent
residents have the right to accept or refuse treatment, including dietary modifications. The
diabetes diagnosis does not automatically remove decision-making capacity. Options A, B,
and D describe appropriate situations (resident choice, minor courtesy issue, and team
planning respectively).
Question 8
A resident with Parkinson's disease exhibits increasing difficulty with activities of daily living.
Which intervention best supports functional independence?
A. Complete all ADLs for the resident to prevent fatigue
B. Provide adaptive equipment and allow extra time for self-care [CORRECT]
C. Restrict fluids to reduce toileting frequency
D. Transfer the resident to a locked unit for safety
Rationale: Option B aligns with F676 (Treatment/Services to Prevent/Heal Pressure Ulcers)
and rehabilitation principles. Adaptive equipment and time accommodations support dignity
and autonomy while maintaining function. Option A promotes dependence. Option C risks
dehydration and urinary complications. Option D is unnecessarily restrictive without
wandering or elopement risk.
