CMS Long-Term Care Surveyor Practice Exam
400 Original Questions • Marked Answers • Regulatory Rationales
Advanced Survey & Compliance Review
A comprehensive original practice resource for learners reviewing long-term care survey methodology, resident rights,
quality of care, clinical compliance, safety, documentation, and deficiency determination.
Table of Contents
1. CMS & Long-Term Care Survey Foundations — focused practice section
2. Survey Preparation & On-Site Process — focused practice section
3. Resident Rights & Quality of Life — focused practice section
4. Abuse, Neglect, Exploitation & Misappropriation — focused practice section
5. Assessment, Care Planning & Quality of Care — focused practice section
6. Clinical Services & Medication Management — focused practice section
7. Nutrition, Hydration, Skin & Elimination — focused practice section
8. Safety, Emergency Preparedness & Environment — focused practice section
9. Staffing, Competency & Quality Improvement — focused practice section
10. Deficiency Determination & Reporting — focused practice section
Answer Design
Correct answers are highlighted in light blue. Rationales are highlighted in pale yellow for quick review.
,CMS & Long-Term Care Survey Foundations
1. A surveyor is reviewing CMS oversight. Which action is most appropriate?
A. Verify the concern through objective evidence before reaching a conclusion.
B. Accept the first explanation without verification.
C. Base the finding on personal preference.
D. Document a deficiency without supporting evidence.
Correct Answer: A
Rationale: Survey findings should be based on objective, sufficient evidence rather than assumptions or personal preference.
2. During a review of CMS oversight, which finding would most strongly indicate a potential
complianceconcern?
A. A minor clerical issue with no resident-care impact.
B. A repeated practice that places residents at risk or fails to meet an applicable requirement.
C. A resident preference that is unrelated to safety or rights.
D. A staff member's unsupported opinion.
Correct Answer: B
Rationale: Repeated practices that create risk or fail to meet applicable requirements warrant focused follow-up and evidence
collection.
3. A resident reports a concern involving CMS oversight. What should the surveyor do next?
A. Immediately assign a deficiency without further evidence.
B. Ask the resident to resolve the issue independently.
C. Follow up using appropriate interviews, observations, and records to determine whether the concern is substantiated.
D. Dismiss the concern because it is based on an interview.
Correct Answer: C
Rationale: Resident interviews can identify important leads. The surveyor should investigate the concern through appropriate
sources before making a determination.
4. The facility presents a written policy about CMS oversight, but survey observations show different
practice.Which approach is best?
A. Assume compliance because a policy exists.
B. Ignore the observations.
C. Accept the policy as proof that staff followed it.
D. Evaluate actual practice against the applicable requirements and determine whether the difference is significant.
Correct Answer: D
Rationale: A written policy does not by itself establish compliance. Surveyors evaluate actual practice and compare evidence with
applicable requirements.
5. When documenting a finding related to CMS oversight, the surveyor should:
A. Describe specific, factual evidence and explain how it supports the finding.
B. Use vague conclusions without dates or observations.
, C. Include assumptions about staff intent.
D. Document only the facility's response.
Correct Answer: A
Rationale: Clear, factual documentation makes the finding understandable, reproducible, and defensible.
6. Which surveyor behavior best supports accurate evaluation of CMS oversight?
A. Ignore contradictory evidence.
B. Remain objective, gather corroborating evidence, and avoid conflicts of interest.
C. Advocate for the facility being surveyed.
D. Change the standard based on personal relationships.
Correct Answer: B
Rationale: Objectivity, corroboration, and avoidance of conflicts of interest are essential to credible survey work.
7. A surveyor is reviewing federal requirements. Which action is most appropriate?
A. Document a deficiency without supporting evidence.
B. Verify the concern through objective evidence before reaching a conclusion.
C. Accept the first explanation without verification.
D. Base the finding on personal preference.
Correct Answer: B
Rationale: Survey findings should be based on objective, sufficient evidence rather than assumptions or personal preference.
8. During a review of federal requirements, which finding would most strongly indicate a potential
complianceconcern?
A. A staff member's unsupported opinion.
B. A minor clerical issue with no resident-care impact.
C. A repeated practice that places residents at risk or fails to meet an applicable requirement.
D. A resident preference that is unrelated to safety or rights.
Correct Answer: C
Rationale: Repeated practices that create risk or fail to meet applicable requirements warrant focused follow-up and evidence
collection.
9. A resident reports a concern involving federal requirements. What should the surveyor do next?
A. Dismiss the concern because it is based on an interview.
B. Immediately assign a deficiency without further evidence.
C. Ask the resident to resolve the issue independently.
D. Follow up using appropriate interviews, observations, and records to determine whether the concern is substantiated.
Correct Answer: D
Rationale: Resident interviews can identify important leads. The surveyor should investigate the concern through appropriate
sources before making a determination.
10. The facility presents a written policy about federal requirements, but survey observations show
differentpractice. Which approach is best?
, A. Evaluate actual practice against the applicable requirements and determine whether the difference is significant.
B. Assume compliance because a policy exists.
C. Ignore the observations.
D. Accept the policy as proof that staff followed it.
Correct Answer: A
Rationale: A written policy does not by itself establish compliance. Surveyors evaluate actual practice and compare evidence with
applicable requirements.
11. When documenting a finding related to federal requirements, the surveyor should:
A. Document only the facility's response.
B. Describe specific, factual evidence and explain how it supports the finding.
C. Use vague conclusions without dates or observations.
D. Include assumptions about staff intent.
Correct Answer: B
Rationale: Clear, factual documentation makes the finding understandable, reproducible, and defensible.
12. Which surveyor behavior best supports accurate evaluation of federal requirements?
A. Change the standard based on personal relationships.
B. Ignore contradictory evidence.
C. Remain objective, gather corroborating evidence, and avoid conflicts of interest.
D. Advocate for the facility being surveyed.
Correct Answer: C
Rationale: Objectivity, corroboration, and avoidance of conflicts of interest are essential to credible survey work.
13. A surveyor is reviewing survey purpose. Which action is most appropriate?
A. Base the finding on personal preference.
B. Document a deficiency without supporting evidence.
C. Verify the concern through objective evidence before reaching a conclusion.
D. Accept the first explanation without verification.
Correct Answer: C
Rationale: Survey findings should be based on objective, sufficient evidence rather than assumptions or personal preference.
14. During a review of survey purpose, which finding would most strongly indicate a potential
complianceconcern?
A. A resident preference that is unrelated to safety or rights.
B. A staff member's unsupported opinion.
C. A minor clerical issue with no resident-care impact.
D. A repeated practice that places residents at risk or fails to meet an applicable requirement.
Correct Answer: D
Rationale: Repeated practices that create risk or fail to meet applicable requirements warrant focused follow-up and evidence
collection.
15. A resident reports a concern involving survey purpose. What should the surveyor do next?
400 Original Questions • Marked Answers • Regulatory Rationales
Advanced Survey & Compliance Review
A comprehensive original practice resource for learners reviewing long-term care survey methodology, resident rights,
quality of care, clinical compliance, safety, documentation, and deficiency determination.
Table of Contents
1. CMS & Long-Term Care Survey Foundations — focused practice section
2. Survey Preparation & On-Site Process — focused practice section
3. Resident Rights & Quality of Life — focused practice section
4. Abuse, Neglect, Exploitation & Misappropriation — focused practice section
5. Assessment, Care Planning & Quality of Care — focused practice section
6. Clinical Services & Medication Management — focused practice section
7. Nutrition, Hydration, Skin & Elimination — focused practice section
8. Safety, Emergency Preparedness & Environment — focused practice section
9. Staffing, Competency & Quality Improvement — focused practice section
10. Deficiency Determination & Reporting — focused practice section
Answer Design
Correct answers are highlighted in light blue. Rationales are highlighted in pale yellow for quick review.
,CMS & Long-Term Care Survey Foundations
1. A surveyor is reviewing CMS oversight. Which action is most appropriate?
A. Verify the concern through objective evidence before reaching a conclusion.
B. Accept the first explanation without verification.
C. Base the finding on personal preference.
D. Document a deficiency without supporting evidence.
Correct Answer: A
Rationale: Survey findings should be based on objective, sufficient evidence rather than assumptions or personal preference.
2. During a review of CMS oversight, which finding would most strongly indicate a potential
complianceconcern?
A. A minor clerical issue with no resident-care impact.
B. A repeated practice that places residents at risk or fails to meet an applicable requirement.
C. A resident preference that is unrelated to safety or rights.
D. A staff member's unsupported opinion.
Correct Answer: B
Rationale: Repeated practices that create risk or fail to meet applicable requirements warrant focused follow-up and evidence
collection.
3. A resident reports a concern involving CMS oversight. What should the surveyor do next?
A. Immediately assign a deficiency without further evidence.
B. Ask the resident to resolve the issue independently.
C. Follow up using appropriate interviews, observations, and records to determine whether the concern is substantiated.
D. Dismiss the concern because it is based on an interview.
Correct Answer: C
Rationale: Resident interviews can identify important leads. The surveyor should investigate the concern through appropriate
sources before making a determination.
4. The facility presents a written policy about CMS oversight, but survey observations show different
practice.Which approach is best?
A. Assume compliance because a policy exists.
B. Ignore the observations.
C. Accept the policy as proof that staff followed it.
D. Evaluate actual practice against the applicable requirements and determine whether the difference is significant.
Correct Answer: D
Rationale: A written policy does not by itself establish compliance. Surveyors evaluate actual practice and compare evidence with
applicable requirements.
5. When documenting a finding related to CMS oversight, the surveyor should:
A. Describe specific, factual evidence and explain how it supports the finding.
B. Use vague conclusions without dates or observations.
, C. Include assumptions about staff intent.
D. Document only the facility's response.
Correct Answer: A
Rationale: Clear, factual documentation makes the finding understandable, reproducible, and defensible.
6. Which surveyor behavior best supports accurate evaluation of CMS oversight?
A. Ignore contradictory evidence.
B. Remain objective, gather corroborating evidence, and avoid conflicts of interest.
C. Advocate for the facility being surveyed.
D. Change the standard based on personal relationships.
Correct Answer: B
Rationale: Objectivity, corroboration, and avoidance of conflicts of interest are essential to credible survey work.
7. A surveyor is reviewing federal requirements. Which action is most appropriate?
A. Document a deficiency without supporting evidence.
B. Verify the concern through objective evidence before reaching a conclusion.
C. Accept the first explanation without verification.
D. Base the finding on personal preference.
Correct Answer: B
Rationale: Survey findings should be based on objective, sufficient evidence rather than assumptions or personal preference.
8. During a review of federal requirements, which finding would most strongly indicate a potential
complianceconcern?
A. A staff member's unsupported opinion.
B. A minor clerical issue with no resident-care impact.
C. A repeated practice that places residents at risk or fails to meet an applicable requirement.
D. A resident preference that is unrelated to safety or rights.
Correct Answer: C
Rationale: Repeated practices that create risk or fail to meet applicable requirements warrant focused follow-up and evidence
collection.
9. A resident reports a concern involving federal requirements. What should the surveyor do next?
A. Dismiss the concern because it is based on an interview.
B. Immediately assign a deficiency without further evidence.
C. Ask the resident to resolve the issue independently.
D. Follow up using appropriate interviews, observations, and records to determine whether the concern is substantiated.
Correct Answer: D
Rationale: Resident interviews can identify important leads. The surveyor should investigate the concern through appropriate
sources before making a determination.
10. The facility presents a written policy about federal requirements, but survey observations show
differentpractice. Which approach is best?
, A. Evaluate actual practice against the applicable requirements and determine whether the difference is significant.
B. Assume compliance because a policy exists.
C. Ignore the observations.
D. Accept the policy as proof that staff followed it.
Correct Answer: A
Rationale: A written policy does not by itself establish compliance. Surveyors evaluate actual practice and compare evidence with
applicable requirements.
11. When documenting a finding related to federal requirements, the surveyor should:
A. Document only the facility's response.
B. Describe specific, factual evidence and explain how it supports the finding.
C. Use vague conclusions without dates or observations.
D. Include assumptions about staff intent.
Correct Answer: B
Rationale: Clear, factual documentation makes the finding understandable, reproducible, and defensible.
12. Which surveyor behavior best supports accurate evaluation of federal requirements?
A. Change the standard based on personal relationships.
B. Ignore contradictory evidence.
C. Remain objective, gather corroborating evidence, and avoid conflicts of interest.
D. Advocate for the facility being surveyed.
Correct Answer: C
Rationale: Objectivity, corroboration, and avoidance of conflicts of interest are essential to credible survey work.
13. A surveyor is reviewing survey purpose. Which action is most appropriate?
A. Base the finding on personal preference.
B. Document a deficiency without supporting evidence.
C. Verify the concern through objective evidence before reaching a conclusion.
D. Accept the first explanation without verification.
Correct Answer: C
Rationale: Survey findings should be based on objective, sufficient evidence rather than assumptions or personal preference.
14. During a review of survey purpose, which finding would most strongly indicate a potential
complianceconcern?
A. A resident preference that is unrelated to safety or rights.
B. A staff member's unsupported opinion.
C. A minor clerical issue with no resident-care impact.
D. A repeated practice that places residents at risk or fails to meet an applicable requirement.
Correct Answer: D
Rationale: Repeated practices that create risk or fail to meet applicable requirements warrant focused follow-up and evidence
collection.
15. A resident reports a concern involving survey purpose. What should the surveyor do next?
