NAB NHA Exam Questions and Answers 2024, Exams of Nursing

Download NAB NHA Exam Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 NAB NHA Exam Questions and Answers 2024 Where changes are made to charges for other items and services that the facility offers, the facility must inform the resident in writing at least - Answer 60 days prior to implementation of the change. The facility must provide the resident with access to personal and medical records pertaining to their self, upon an oral and written request, in the form and format requested by the individual, if it is readily producible in such form and format (including in an electronic form or format when such records are maintained electronically) or if not, in a readable hard copy form or such other form agreed to by the facility and the individual within - Answer 24 hours The facility must allow the resident to obtain a copy of the records or any portion there of upon request and - Answer 2 working days advance notice to the facility The facility must have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility along with plans of correction in effect with respect to the facility, available for any individual to review upon request. - Answer 3 preceding years The facility must notify each resident that receives Medicaid benefits when the amount in the residents account reaches - Answer $200 less than the SSI resource limit The facility must deposit the resident's personal funds in excess of $ in an interest bearing account that is separate from any of the facility's operating accounts, and that credits all interest earned on resident's funds to that account. - Answer $50 (iv) The facility must refund to the resident or resident representative any and all refunds due the resident within - Answer 30 days from the resident's date of discharge from the facility. Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of - Answer 71 to 81 °F Maintaining evidence demonstrating the results of all grievances for a period of no less than - Answer 3 years from the issuance of the grievance decision. (B) Each covered individual shall report immediately, but not later than 2 after forming the suspicion, if the events that cause the suspicion result in serious bodily injury, or not later than if the events that cause the suspicion do not result in serious bodily injury. - Answer 2 hours or 24 hours Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury - Answer 2 hours not later than hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. - Answer 24 Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within of the incident, and if the alleged violation is verified appropriate corrective action must be taken. - Answer 5 working days the notice of transfer or discharge required under this section must be made by the facility at least days before the resident is transferred or discharged. - Answer 30 Comprehensive careplan. Within calendar days after admission, excluding readmissions in which there is no significant change in the resident's physical or mental condition. (For purposes of this section, "readmission" means a return to the facility following a temporary absence for hospitalization or for therapeutic leave.) - Answer 14 Comprehensive care plan. Within calendar days after the facility determines, or should have determined, that there has been a significant change in the resident's physical or mental condition. (For purposes of this section, a "significant change" means a major decline or improvement in the resident's status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one area of the resident's health status, and requires interdisciplinary review or revision of the care plan, or both.) - Answer 14 Quarterly review assessment. A facility must assess a resident using the 5 Paternal, sympathetic, parenting - Answer You do your job-I'll take of leave, raises, benefits Autocratic - Answer Dictatorial, threatening, intimidating. No confidence in staff; he knows all. "Don't care if he likes me or not - just so work gets done." Situational - Answer Leaders adapt their style at times to meet the circumstances in which they are working and/or the type of employee they are leading. OSCAR System - Answer Online Survey Certification and Reporting (OSCAR) system - All Nursing homes must input assessment and care plan information. Surveyors use in planning focus of survey. Risk Management - Answer Program to reduce occurrences (incidents) that may lead to action damaging to facility and it's reputation. Economic loss through tort action-civil suit. Primarily to protect facility, but also to protect residents, staff, and visitors. Deficiency scope - Answer How many residents involved - -isolated - one or a limited number of residents affected; occurs occasionally in limited number of locations -pattern - more than very limited number of residents are affected. -widespread - pervasive in facility, systematic, affected large portion or all of the facility. Level of deficiency - Answer How much harm to residents: -Level 1 - No Actual harm with potential for minimal harm; minor negative impact on residents 6 -Level 2 - No actual harm with potential for more than minimal harm; Example: Medication error rate, harm of short duration as falls, a laceration, etc. easy to remedy. -Level 3 - Actual harm that is not immediate jeopardy. A negative outcome that has comprised resident's ability to maintain or reach highest level of functioning. Example: pressure sore of urinary tract infection occuring after admission. Level 4 - Immediate jeopardy. Immediate corrective action necessary because noncompliance in one or more requirements has caused or is likely to case serious injury or harm, impairment or death. Example: nurse call system not functioning, severe staffing shortages. Plan of correction (exit interview from surveyor) - Answer Facility submits plan of correction showing: -how corrective action will be taken for residents affected by deficient practice -how facility will identify other residents having potential to be affected by the deficient practice -what measures or changes will be made to ensure non-recurrence. -how corrective actions to be monitored to ensure non-recurrence. delusions - Answer false beliefs, often of persecution or grandeur, that may accompany psychotic disorders Hallucinations - Answer false sensory experiences, such as seeing something in the absence of an external visual stimulus Dementia - Answer a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes Alzheimer's disease - Answer an irreversible, progressive brain disorder, characterized by the deterioration of memory, language, and eventually, 7 physical functioning Uniform (minimum) data set (MDS) - Answer use instrument specified by the state and approved by CMS, describe resident's present level of functioning in four activities of daily liviing (ADL'S) and potential for improvement or regression. How long must the facility keep MDS assessments? - Answer Must keep 15 months of MDS records Frequency of MDS assessments (long term care) - Answer Must complete assessment 14 days after admission, quarterly (no more than 92 days), annual (full), significant changes. Frequency of MDS assessments (short term rehab) - Answer 5 day, 14 day, 30 day, 60, 90, and if there is a significant change Significant change - Answer -must see deterioration or improvement in 2 or more ADL's that we do not expect to be improved in itself. -deterioration of two or more ADL's, in cognitive abilities, or communication that appears permanent -loss of ambulation or use of hands to grasp small object to feed or groom -deterioration in mood or behavior to the point where daily problems arise, or relationship problems develop -deterioration of health status -improvement to point where care is no longer needed Dental Service - Answer Provide or obtain from outside services -24 hour emergency care-acute pain, damaged tooth. 10 Menus - Answer must meet nutritional needs according to Food and Nutrition Board of Research Council, NRC (National Academy of Sciences) -State determines retention Food classes that provide RDA's (daily) - Answer 4 oz meat 2 cups of fruit/vegetables 4 servings of break/cereal 2 cups of milk (a class not eaten - alternative means to meet needs: nutritional supplements) Inventory on hand - Answer Three days supply of perishables Seven days supply of staples --These are standards of practice but the administrator should anticipate the type of catastrophe his/her facility may suffer and plan accordingly. Weight loss - Answer Interval Significant loss Severe loss 1 month 5% Greater than 5% 3 months 7.5% Greater than 7.5% 6 months 10% Greater than 10% How to calculate weight loss percentage - Answer % loss = usual weight less actual / usual weight X 100 Example: 110-100/110 X 100 = 9% Meals - Answer 3 daily - no longer than 14 hours between evening meal and breakfast - 16 hours with substantial snacks and OK from resident's council. 11 (snacks must meet RDA's) Therapeutic diets - Answer PRESCRIBED BY PHYSICIAN, APPROVED BY DIETICIAN Feeding residents - Answer According to CMS only licensed speech therapist, LPN, RN, CNA allowed to feed. Food temperature - Answer 41 degrees - 135 degrees -Frozen food must be kept frozen "solidly" according to regulations - Serving hot food - must leave the kitchen or steam table at 135 degrees or above. Cold foods 41 degrees or below when leave kitchen. Dishwashing temperatures - Answer --High temperature dishwasher- wash cycle 150-165 degrees recommendation. Rinse cycle 180 degrees -- Low temperature dishwasher (chemical sanitation) wash 120 degrees and final rinse 50ppm (parts per million) hypochlorite (chlorine) on dish final rinse Cost of Raw Food - Answer figured by dividing total cost by # of resident days 100 residents X 30 days = 3,000 $15,000 / 3,000 = $5.00 ppd (per patient day) Physician Services - Answer Every resident have own physician - MD or DO only can admit and serve as attending physician. Back up physician. -Role in admission and assessment -Responsible for total programs of care Physician visits - Answer Once every 30 days for the first 90 days, every 60 days 12 thereafter. --Up to 10 days late OK. --Next visit must be counted from regularly scheduled date Changing MD - Answer supposed to do new history, new orders, written release from prior MD Medical records content and format - Answer CMS requires: A. identification data - social history, SS#, doctor, family B. Assessments C. Plan of care and services provided D. Preadmission screening results E. progress notes F. Closing data when discharged (checked by surveryors) G. Correcting charting error: mark through, correct, date, initial; by person who made error. H. Discharge summary includes: ---recap of resident's stay ---final summary of status ---post d/c plan ---must be completed 90 days after discharge Confidentiality of Medical records - Answer No release without consent except: -transfer -court order -third party agreement (surveyors) Medical records Ownership and accessibility - Answer Belongs to facility. New 15 Personnel records - Answer Purpose: to provide factual information for making objective personnel decisions. Not required by CMS, but required by Wage & Hours, EEOC, INS, state etc COBRA - Answer health insurance - protects health insurance coverage when workers change or lose job. To qualify must: 1. Can continue coverage for up to 18 months, but must pay premium 2. Most recent insurance must have been under a group plan 3. Not eligible for Medicare or Medicaid or have coverage under another insurance plan HIPPA - Answer ensures the confidentiality of medical records. It still being implemented and changed. **Documentation available to Medicare/Medicaid and other government agencies. No federal law that employee see record. Unions: Things you CAN'T do (SPIT) - Answer Threaten to fire, demote Interrogate - question if for or against, attend meetings, or sign card| Promise raise, promotion or other benefit Surveillance - may not watch to see who attends meetings, discusses union and passes out literature on his own time. **Administrator cannot attend union meetings Supervisor speaks for union - do not fire. Clarify Facility stand on unionizing. Election of Union - Answer NLRB may call election when 30% sign cards. 50% plus one who vote determine outcome of election Employee rights with Union - Answer Unions seek to become the bargaining agent. 16 -They cannot approach employees on job; can when not on duty. -Cannot pass out literature in patient areas; can in non-patient areas. What to do if Unionized - Answer determine in advance the essential demands and what you will do before contract negotiations. Have written plan. Mediation (union term) - Answer Third party tries to get parties to agree Arbitration (Union term) - Answer Opposing parties agree to abide by decision of the arbiter Decertification (Union term) - Answer If dissatisfied with union, members of union may petition NLRB for decertification election at end of contract. ***Never sign more than one year contract. "closed shops" - Answer Ones in which the employer and the union agree that the employer will only hire union members "Union" shops - Answer Businesses in which employers are free to hire non-union members, but union membership is required within a specified period of type (often 30 days) as a condition of continued employment "Agency" shops - Answer Employers can choose to hire either union or non-union members, and the labor union serves as a bargaining agent for all employees. While non-unionized workers don't have to join the union as a condition of continued employment, all employees must pay union dues, regardless of union membership Employee Health and Safety - Answer CMS mandates safe and healthy environment for staff, residents, and public. 17 OSHA mandates safe, healthy workplace, for employees to work in (g) Nurse staffing information—(1) Data requirements. The facility must post the following information on a daily basis: - Answer (i) Facility name. (ii) The current date. (iii) The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: (A) Registered nurses. (B) Licensed practical nurses or licensed vocational nurses (as defined under State law). (C) Certified nurse aides. (iv) Resident census. (2) Posting requirements. (i) The facility must post the nurse staffing data specified in paragraph (e)(1) of this section on a daily basis at the beginning of each shift. - Answer (ii) Data must be posted as follows: (A) Clear and readable format. (B) In a prominent place readily accessible to residents and visitors. (3) Public access to posted nurse staffing data. The facility must, upon oral or written request, make nurse staffing data available to the public for review at a cost not to exceed the community standard. (4) Facility data retention requirements. The facility must maintain the posted daily nurse staffing data for a minimum of ****18 months******, or as required by State law, whichever is greater. An unnecessary drug is any drug when used— - Answer (1) In excessive dose (including duplicate drug therapy); or (2) For excessive duration; or (3) Without adequate monitoring; or 20 (4) Must have a policy identifying those circumstances when the loss or damage of dentures is the facility's responsibility and may not charge a resident for the loss or damage of dentures determined in accordance with facility policy to be the facility's responsibility; and (5) Must assist residents who are eligible and wish to participate to apply for reimbursement of dental services as an incurred medical expense under the State plan. A qualified dietitian or other clinically qualified nutrition professional either full-time, part-time, or on a consultant basis. A qualified dietitian or other clinically qualified nutrition professional is one who — - Answer (i) Holds a bachelor's or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics accredited by an appropriate national accreditation organization recognized for this purpose. (ii) Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional. (iii) Is licensed or certified as a dietitian or nutrition professional by the State in which the services are performed. In a state that does not provide for licensure or certification, the individual will be deemed to have met this requirement if he or she is recognized as a "registered dietitian" by the Commission on Dietetic Registration or its successor organization, or meets the requirements of paragraphs (a)(1)(i) and (ii) of this section. (iv) For dietitians hired or contracted with prior to November 28, 2016, meets these requirements no later than 5 years after November 28, 2016 or as required by state law. Therapeutic diets. - Answer Therapeutic diets must be prescribed by the attending physician. ---The attending physician may delegate to a registered or licensed dietitian the task of prescribing a resident's diet, including a therapeutic diet, to the extent allowed by State law. 21 Governing body. - Answer The facility must have a governing body, or designated persons functioning as a governing body, that is legally responsible for establishing and implementing policies regarding the management and operation of the facility (2) The governing body appoints the administrator who is — - Answer (i) Licensed by the State, where licensing is required; (ii) Responsible for management of the facility; and (iii) Reports to and is accountable to the governing body. (1) The facility's resident population, including, but not limited to, - Answer (i) Both the number of residents and the facility's resident capacity; (ii) The care required by the resident population considering the types of diseases, conditions, physical and cognitive disabilities, overall acuity, and other pertinent facts that are present within that population; (iii) The staff competencies that are necessary to provide the level and types of care needed for the resident population; (iv) The physical environment, equipment, services, and other physical plant considerations that are necessary to care for this population; and (v) Any ethnic, cultural, or religious factors that may potentially affect the care provided by the facility, including, but not limited to, activities and food and nutrition services. Facility assessment. - Answer The facility must conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies. The facility must review and update that assessment, as necessary, and at least annually. The facility must also review and update this assessment whenever there is, or the facility plans for, any change that would require a substantial modification to any part of this assessment. The facility assessment must address or include: 22 (2) The facility must provide written notice to the State agency responsible for licensing the facility at the time of change, if a change occurs in — - Answer (i) Persons with an ownership or control interest, as defined in §§420.201 and 455.101 of this chapter; (ii) The officers, directors, agents, or managing employees; (iii) The corporation, association, or other company responsible for the management of the facility; or (iv) The facility's administrator or director of nursing. Facility closure-Administrator. - Answer Any individual who is the administrator of the facility must: (1) Submit to the State Survey Agency, the State LTC ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure: (i) At least 60 days prior to the date of closure; or (ii) In the case of a facility where the Secretary or a State terminates the facility's participation in the Medicare and/or Medicaid programs, not later than the date that the Secretary determines appropriate; (2) Ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and (3) Include in the notice the plan, that has been approved by the State, for the transfer and adequate relocation of the residents of the facility by a date that would be specified by the State prior to closure, including assurances that the residents would be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident. (2) Submission requirements. The facility must electronically submit to CMS complete and accurate direct care staffing information, including the following: - Answer (i) The category of work for each person on direct care staff (including, but not limited to, whether the individual is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other type of medical personnel as specified by CMS); 25 (5) A means, in the event of an evacuation, to release resident information as permitted under 45 CFR 164.510(b)(1)(ii). (6) A means of providing information about the general condition and location of residents under the facility's care as permitted under 45 CFR 164.510(b)(4). (7) A means of providing information about the LTC facility's occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction or the Incident Command Center, or designee. (8) A method for sharing information from the emergency plan that the facility has determined is appropriate with residents and their families or representatives. Emergency generator location. - Answer The generator must be located in accordance with the location requirements found in the ***Health Care Facilities Code**** (NFPA 99 and **Tentative Interim Amendments TIA 12-2, TIA 12-3, TIA 12-4, TIA 12-5, and TIA 12-6), Life Safety Code***** (NFPA 101 and Tentative Interim Amendments TIA 12-1, TIA 12-2, TIA 12-3, and TIA 12-4), and NFPA 110***, when a new structure is built or when an existing structure or building is renovated. Emergency generator inspection and testing - Answer The LTC facility must implement the emergency power system inspection, testing, and maintenance requirements found in the Health Care Facilities Code, NFPA 110, and Life Safety Code. QAPI program - Answer (4) Present documentation and evidence of its ongoing QAPI program's implementation and the facility's compliance with requirements to a State Survey Agency, Federal surveyor or CMS upon request. A facility must maintain a quality assessment and assurance committee consisting at a minimum of: - Answer (i) The director of nursing services; (ii) The Medical Director or his or her designee; (iii) At least three other members of the facility's staff, at least one of who must be the administrator, owner, a board member or other individual in a leadership 26 role; and (iv) The infection preventionist. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: - Answer (1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards; (2) Written standards, policies, and procedures for the program, which must include, but are not limited to: (b) Infection preventionist. The facility must designate one or more individual(s) as the infection preventionist(s) (IPs) who are responsible for the facility's IPCP. The IP must: - Answer (1) Have primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field; (2) Be qualified by education, training, experience or certification; (3) Work at least part-time at the facility; and (4) Have completed specialized training in infection prevention and control. ***(c) IP participation on quality assessment and assurance committee. The individual designated as the IP, or at least one of the individuals if there is more than one IP, must be a member of the facility's quality assessment and assurance committee and report to the committee on the IPCP on a regular basis. Influenza immunization - Answer residents must be offered the immunization October 1 - March 31. The resident or resident representative has the right to refuse, must document what they choose. Pneumococcal disease. The facility must develop policies and procedures to ensure that— - Answer side effects are explained, immunization is offered. 27 Document if accepted or declined. Infection prevention and control program review - Answer The facility will conduct an annual review and update their program as necessary. Compliance officer - Answer (2) A designated compliance officer for whom the operating organization's compliance and ethics program is a major responsibility. This individual must report directly to the operating organization's governing body and not be subordinate to the general counsel, chief financial officer or chief operating officer. Environmental provisions the facility must meet in accordance with who? - Answer (i) The LTC facility must meet the applicable provisions and must proceed in accordance with the Life Safety Code (NFPA 101 and Tentative Interim Amendments TIA 12-1, TIA 12-2, TIA 12-3, and TIA 12-4.)