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Federal Nursing Home Administrator
Exam
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? - Answer--Infection Control
Nursing homes are responsible for obtaining and providing dental care for residents. Who usually pays for dental services? - Answer--The resident or a family member
A facility is not allowed to charge a resident who is Medicaid and Medicare eligible except for: - Answer--Co-pays
You calculate the average percent of occupancy by: - Answer--Dividing the total census (occupied bed days) by the total number of days, then multiply by 100
Resident's rights should be explained to the resident and or family member: - Answer--Prior to admission
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: - Answer--Administrator
Federal law states that facilities must retain menus of food actually served for at least: - Answer--30 days
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? - Answer--Provide the CPR
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? - Answer--Tell the doctor the law gives the resident the right to view the medical records
Medical records belong to: - Answer--Facility
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: - Answer-- days
The suffix "algia" refers to: - Answer--Pain
Physical restraints must be removed: - Answer--Every two hours
Depression is one of many psychological changes related to the aging process. Others include the following except for: - Answer--Hearing loss
"Nosocomal" refers to - Answer--Infection occurring inside the facility (institutionalized)
A capital budget is mostly about: - Answer--Equipment and real estate
Current debts are debts that are: - Answer--Due within one year
A ledger is a complete listing of: - Answer--Accounts payable and receivable
Which resource usually provides the least revenue for a nursing home? - Answer--Insurance
Past due accounts should not exceed: - Answer--5%
All of the following are a cash expense except: - Answer--Depreciation
A pro forma is primarily - Answer--A financial statement or prediction
A function of management is controlling, which means: - Answer--Measuring outcomes against benchmarks, then responding
The most overlooked aspect of communication in health facilities is: - Answer--Two way feedback loops
Of the following, the task management performs that contribute most effectively and positively to morale is: - Answer--Discipline consistentlyr and fairly
In a bargaining unit, only ____ need to sign a card to call a union election: - Answer--30 percent
During an interview or on a job application, you may ask for all except: - Answer--Place of Birth
To be eligible for FMLA, an employee must first work - Answer--1250 hours in the last 12 months
If an employee works 52 hours in one week at a rate of $7 per hour, what would be the total gross salary? - Answer--$
Fire safety regulations come primarily from: - Answer--LSC Life Safety Code
The purpose of an enunciator panel is to: - Answer--Indicate the zone of a fire
Generators must be checked - Answer--montly
Employee's Right to know refers to - Answer--Hazardous communicatins
The primary fire - defense tools of a nursing home staff are: - Answer--Smoke barriers, corridor walls, and resident rooms
A maintenance program that saves time and money focuses on: - Answer--Preventive maintenance
Class C fires involve: - Answer--Electricity
PHYSICAL ENVIRONMENT ANT ATMOSPHERE - Answer--
PHYSICAL ENVIRONMENT ANT ATMOSPHERE - Answer--
- Indoor temperatures - Answer--71 - 81 degrees ferinhight
Disaster plans - Answer--OBRA requirement for written plan
Life Safety Code - Answer--Reasonably ensure the public protection from fire in public buildings
MSDS - Answer--Information on potentially hazardous material
OSHA - Answer--federal agency overseeing employee safety
NFPA - Answer--establishes LSC
Personnal Protective Equipment - Answer--gloves
Preventative measures - Answer--time for schedules repairs
Offer HBV - Answer--within 10 working days
Smoke compartments - Answer--200 feet or less
Occupant loads for exit requirements: - Answer--one person per 120 sq ft of floor area in sleeping areas and one person per 240 sq ft in treatment areas
Means of Egress Requirements Emergency lighting: - Answer--Mandatory and Automatically available not requiring manual intervention for continuous operation when power is interupted
Means of Egress Requirements Exit Marking: - Answer--clearly marked with signs no more than 100 feet from exit
Emergency Power: - Answer--Check generator weekly, test under full load for 30 minutes monthly
Handrails at bottom of stairs must be: - Answer--extended parallel to floor for 12 inches
Windows must have opening force requirement: - Answer--of no more than 5 lbs.
Generator should provide for full load for - Answer--4 hours, under emergency power need
In-Out migration - Answer--Movements of workers in and out of geographic area
Pool - Answer--Group of temporary workers
Labor Market - Answer--geographic area of recruitment
Union election - Answer--NLRB conducts; 50% plus 1 potential bargaining unit members VOTING wins
LEADERSHIP AND MANAGEMENT (23% - 35 questions) - Answer--
Strategic Planning - Answer--setting long term goals
Case mix - Answer--residents categorized by acuity
Governing body - Answer--legally responsible for management
Tactical planning - Answer--selecting goals for one year
Management - Answer--achieve common goals thru organization
Market segment - Answer--potential users of services
Payor mix - Answer--residents categorized by payment type
Rules - Answer--commands for action or non-action
Procedures - Answer--required methods for handling activities
Risk management - Answer--proactive means of anticipating problems
Staff authority - Answer--advisory relationship with line management
Forecasting - Answer--projects trends and needs which facility management must decide in future economic, social and political environment expected and resources available.
Bench Marking - Answer--improve business by comparing with best practice of others (standards from which you measure)
Upper-Level management - Answer--responsible for the overall functioning of the facility, normally interacting directly with the Board of Directors and/or owners.
Middle-Level management - Answer--report to upper-level while interacting with lower-level (DON)
Lower-level management - Answer--directly supervise the staff who do the actual work
Line Position (Authority): - Answer--empowered by administrator to make decisions for organization (DON can fire, fire, give orders)
Staff Position (Authority) - Answer--not empowered to make decisions; duties are primarily to advise (consultants, pharmacists, accountants, etc.)
Functional Authority - Answer--action outside the normal lines of authority
- Violates unity of command
- Necessary due to principle of exception The two often have edges of distinction blurred
Actionable - Answer--conduct giving rise to legal action
Aggrieved party - Answer--one whose rights invaded or who suffered injury
Burden of proof - Answer--obligation of person bringing action
Liable - Answer--written defamation
Slander - Answer--verbal defamation
Malice - Answer--intentional doing of wrongful act
Tort - Answer--a wrong: legal duty owed, breached, and harm occured
Worker Comp: - Answer--responsible for injuries occurring at work
Scope of Employment: - Answer--range of employee activities (resident services by omission or commission)
Depreciation - Answer--spreading of cost of capital assests over useful life
Operating Statement - Answer--total revenues - total expenses =net income (loss)138)
Working Capital - Answer--Current assets - current liabilities
Entity Concept: - Answer--The facility, its records and monies are separate from owners. Ensuring consistency in accounting through full ownership disclosure.
On-Going Concern: - Answer--The facility will continue to operate INDEFINITLEY
Consistency: - Answer--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
Full Disclosure: - Answer--All information must be shown in financial records accurately reflecting the financial standing of the facility
Cash Accounting: - Answer--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
Time period: - Answer--Accounting period (12 months) will be consistent year to year
Objective Evidence: - Answer--Accounting records are prepared with documentable records kept by facility (Audit Trail)
Accrual Accounting: - Answer--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
Chart of accounts: - Answer--list of every account organized into: Assets, Liabilities, Capital, Revenue, Expenses
Assets: - Answer--things the facility OWN
Liabilities: - Answer--things the facility OWES
Capital: - Answer--Net worth or fund balance
Revenues: - Answer--Earnings
Expenses: - Answer--cost of personnel and supplies used in provision of service
Journals: - Answer--books of original entry (the first place transactions are recorded) Cash receipts, billing, accounts payable (purchases), cash disbursements, payroll, general.
General: - Answer--non-repetitive entries. Used to make adjustments to conform to accrual system.
Double entry: - Answer--two entries for each transaction DEBIT and CREDIT
General Ledger: - Answer--summary of all debits and credits contained in all the journals for the time period.
- Continuous balance for each account monthly
- Basis for "trail balance"
Financial Statement: - Answer--summary of all transactions made in a particular time period and their effect on the finances of the facility.
Handling Cash - Answer--Two person procedure; one receives by opening mail or taking in person; the other prepares bank deposit
Collections - Answer--policy for deliquent bills. MUST BE CONSISTENT with all payment types; in not facility could be charged with fraud.
Payroll - Answer--largest expense (50-70% of operational) controlled by administration
Frequency of Doctor Visits - Answer--Every 30 days for first 90 days, then every 60 days
Access to records - Answer--24 hours of request
Care Plans - Answer--21 days after admissions
Required in service for CENA - Answer--12 hours per year
QA meetings - Answer--Quarterly
Work before NA certified - Answer--4 months
Interest Bearing accounts - Answer--trust funds greater than $
Involuntary Transfer Notice - Answer--30 days
CVA - Answer--Stroke
COPD - Answer--Emphysema, Asthma, Bronchitis
ac - Answer--before meals
Meal service: - Answer--Key to high resident morale. 3-5 meals per day with no more than 14 hours btw evening meal and next breakfast ( if HS snack)
Dishwashing - Answer--wash at 150 to 1600 degrees F
Hot food tray - Answer--leave tray line above 140 degrees F
Cold food - Answer--leave tray line at less than 41*F
Freezer - Answer--0* - 20* F
Refrigeration - Answer--32* - 45*F
Storage - Answer--room temperature
RDA - Answer--Recommended Daily Allowance Bread: 4 servings Fruit/veggies 2 cups Meat: 4 oz Milk: 2 cups
Quality Assurance Committe - Answer--DON, a physician, and 3 other staff members
A. Care plan B. Infection Control C. Pharmacy Committee D. Safety Committe
- Administration - Answer--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 - Answer--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 - Answer--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
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
- Answer--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 - Answer--favorable impress
The candidate for administrator indicated that she consistently choose the charismatic style of leadership. This should __________the interviewer. - Answer--Alert
The cost of providing subacute care to nursing home residents _________ - Answer--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 - Answer--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 - Answer--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
- Answer--Placing him at risk
Periodic shortage of nurses available for nursing home employment _________ - Answer--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 - Answer--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 - Answer--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 _______ - Answer--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 ______ - Answer--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 _________. - Answer--Effectiveness/efficiency
The long term care sector receiving increased funding and attention from the federal government is the ________________. - Answer--Home health care sector
The concept that nursing homes should be reimbursed by states for their actual costs was part of the _______ - Answer--Hatch Amendment
The intense health care cost-shifting efforts among providers such as Medicare, Medicaid and local governments is _____________ - Answer--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 ________ - Answer--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. - Answer--Responding appropriately to priorities
Attempting to find the right person for each well-defined job is known as the management function of __________ - Answer--
The administrator who takes steps that insure the goals are accomplished and that each job is done as planned is successfully ______________ - Answer--Controlling quality
The administrators' job is to assure that the ________employees do the tasks of the organization at an acceptable quality level. - Answer--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 ______ - Answer--Staffing
In the end, it can be said that the administrator's responsiblity to meet resident care needs and facility needs ae ______ - Answer--Both are equal
Superior performance depends on taking exceptional care of residents via superior service and _____ - Answer--Constant innovations
Superior performance for a nursing facility comes through __ - Answer--Innovation in ways to serve residents
The supeb nursingb facility is supurb by virtue of its ____ - Answer--Success in serving the residents
Answering the phones and resident call bells with common courtesy and doing things that work are examples of ______ - Answer--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 ________ - Answer--Common sense, obvious
In a facility of 120 beds, the administrator ____personally performs each of the management tasks. - Answer--Need not
To assure that all the management tasks are successfully accomplished, the administrator of a 120-bed facility will typically divide management into _____ - Answer--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 ____ - Answer--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 ______ - Answer--Director of Nursing
The staff person for whom both upward and downward communication skills are most neccessary is the ____ - Answer--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 ______ - Answer--Be pleased
In the typical nursing facility, the decision-making process is _______ establishment of lower, middle, and upper levels of management. - Answer--Noticeably more complicated than the simple
Among the following positions the _____has no authority to make decisions for the facility. - Answer--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 ______. - Answer--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 _______ - Answer--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 _________
- Answer--Acted on as carrying line authority
As a generalization, it can be asserted that management success belongs to those who ____ - Answer--success prepared for the future
Nursing home administrators should anticipate and successfully prepare for ______ - Answer--Rapid change
The long-term care industry entered a period in which _____chang(s) can be expected.
- Answer--Rapid and far reaching
