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SMQT EXAM 2025 | SOCIAL MODEL OF QUALITY
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What is an Extrapyramidal Symptom (EPS) ---------CORRECT ANSWER---- -------------A neurological side effect that may occur within a few days or years of treatment with antipsychotics. Can include: akathisia, medication- induced Parkinsonism, dystonia. What is Akathesia? ---------CORRECT ANSWER-----------------A distressing feeling of internal restlessnesss that may appear as constant motion, the inability to sit still, fidgeting, pacing or rocking. What is Dystonia? ---------CORRECT ANSWER-----------------Acute, painful, spastic contraction of muscle groups (commonly the neck, eyes and trunk) that often occurs soon after initiating treatment. What is NMS (neuroleptic malignant syndrome)? ---------CORRECT ANSWER-----------------Syndrome related to the use of antipsychotics that presents with a sudden onset of diffuse muscle rigidity, high fever, labile blood pressure, tremor, and cognitive dysfunction. POTENTIALLY FATAL if not treated immediately, including stopping the offending medication. What is Serotonin syndrome? ---------CORRECT ANSWER----------------- Serious clinical condition resulting from overstimulation of serotonin receptors. Commonly related to the use of SSRI's, SNRI's, triptans, and antibiotics. Restlessness, hallucinations, confusion, loss of coordination,
fast heartbeat, rapid changes in blood pressure, increased temperature, overactive reflexes, NV&D. What is Tardive Dyskinesia? ---------CORRECT ANSWER----------------- Abnormal muscle movements such as lip smacking, tongue darting, chewing movements, slow and aimless arm and leg movements. What is considered significant weight loss in 1 month ---------CORRECT ANSWER-----------------5% What is considered significant weight loss in 3 months ---------CORRECT ANSWER-----------------7.5% What is considered significant weight loss in 6 months ---------CORRECT ANSWER-----------------10% Signs and symptoms of Digoxin toxicity? ---------CORRECT ANSWER------- ----------1. Anorexia
- Nausea/Vomiting
- Visual changes
- Bradycardia When is a facility required to complete a Gradual Dose Reduction (GDR)? - --------CORRECT ANSWER-----------------1. Within the first year in which a resident is admitted or medication is prescribed.
- Must attempt a GDR in 2 separate quarters (with at least 1 month in between) unless clinically contraindicated.
What is Title XIX (19)? ---------CORRECT ANSWER----------------- Regulations for Medicaid Components of a Defeciency Statement? ---------CORRECT ANSWER------ -----------1. Regulatory Reference
- Deficient Practice Statement
- Relevance Facts and Findings CMS Core Values ---------CORRECT ANSWER-----------------1. Public service
- Integrity
- Accountability
- Excellance
- Respect LTC Survey Core Skills ---------CORRECT ANSWER-----------------1. Resident centered
- Critical thinking
- Teamwork Practicable ---------CORRECT ANSWER-----------------Capable regardless of circumstances or resources available to support an individual, innate ability Iatrogenesis ---------CORRECT ANSWER-----------------A problem that is caused by a treatment When should you export the survey shell from ACO? ---------CORRECT ANSWER-----------------No more than 5 business days before the survey
Which residents are included in the survey shell? ---------CORRECT ANSWER-----------------1. Offsite selected (70% of the sample)
- Residents with at least 1 MDS in the last 120 days
- Residents for closed record review What does the Certification and Survey Provider Enhanced Reporting (CASPER) contain? ---------CORRECT ANSWER-----------------1.Turnover data 2.Occupancy history 3.Compliance history 4.Demographic What items are required upon entrance to the facility? ---------CORRECT ANSWER-----------------1. Census excluding bed holds
- Matrix for new admits in the last 30 days
- Alphabitized list of residents
- List of residents who smoke Observations of screening residents ---------CORRECT ANSWER------------- ----1. Resident behavior
- Staff-resident interactions
- Resident grooming and cleanliness
- Strong urinary odors
- Evidence of abuse/neglect How many complaint/FRI residents are in the inital pool? ---------CORRECT ANSWER----------------- 5
- Infection control
- Kitchen
- Medication administration
- Medication storage
- QAA/QAPI
- Resident Council meeting
- Sufficient and Competent nurse staff What 3 tasks are assigned to all surveyors? ---------CORRECT ANSWER--- --------------1. Dining Observation
- Infection Control
- Sufficient and Competent nurse staff Triggered Facility Tasks ---------CORRECT ANSWER-----------------1. Environment
- Personal Funds
- Resident Assessment What is included in a Baseline Care Plan? ---------CORRECT ANSWER----- ------------1. Initial goals based on admission orders
- MD orders including dietary orders
- Therapy and Social Services
- PASARR What is a Pre-Admission Screening and Resident Review (PASARR)? ------ ---CORRECT ANSWER-----------------Screening to ensure that the facility coordinates with the appropriate, States designated authority, to ensure that individuals with a mental disorder, intellectual disability, or a related condition receive care and services in the most integrated setting appropriate to their needs.
What pathway is used to investigate Quality of Care (QOC) concerns that have no pathway? ---------CORRECT ANSWER-----------------General CE Pathway Can an interviewee's identity be revealed if the facility appeals a cited deficiency and the deficiency is based on information from the interview? --- ------CORRECT ANSWER-----------------Yes What information is discussed at the team meeting end of day 1? --------- CORRECT ANSWER-----------------1. Any newly identified harm or IJ concerns
- Need to expand sample to rule out SQC
- Status for any complaint/FRI
- Pertinent findings
- Work left to complete
- Need to adjust workload
- Status of 3 representative interviews
- Concerns indicative of system failure What is reviewed during the Infection Control task? ---------CORRECT ANSWER-----------------*All surveyors observe for breaks in infection control throughout the survey.
- Infection Prevention and Control Program
- Antibiotic Stewardship
- 5 residents for vaccinations
- Transmission Based Precautions
- Water Management
- Laundry Services
- Infection Preventionist training
- Initial Pool Process
- Sample Selection
- Investigation
- Ongoing Investigations and Facility Tasks
- Potential Citations How wide must an exit corridor be? ---------CORRECT ANSWER-------------- ---8 feet Antipsychotic Medications ---------CORRECT ANSWER-----------------1. Thorazine (Chlorpromazine)
- Haldol (Haloperidol)
- Abilify (Aripiprazole)
- Clozaril (Clozapine)
- Zyprexa (Olanzapine)
- Latuda (Lurasidone)
- Seroquel (Quetipine)
- Risperdal (Risperidone) What to look for during unnecessary medication investigation? --------- CORRECT ANSWER-----------------1. Excessive dose
- Excessive duration
- Adequate monitoring
- Indication for use
- Use in presence of adverse consequences What is a Psychotropic drug? ---------CORRECT ANSWER-----------------Any drug that affects brain activities associated with mental processes and behavior-include anti-psychotic, antidepressant, anti-anxiety and hypnotic medications
Anticholinergic Side Effect ---------CORRECT ANSWER-----------------1. dry mouth
- blurred vision
- tachycardia
- urinary retention
- constipation
- confusion
- delirium
- hallucinations
- increased blood pressure Antibiotic Stewardship requirements ---------CORRECT ANSWER------------- ----1. Antibiotic use protocol on prescribing
- Protocol to determine if antibiotic is indicated
- Process for review of antibiotic use by prescribers
- Protocols to ensure residents are prescribed appropriate antibiotic
- System for feedback reports Avoidable Decline ---------CORRECT ANSWER-----------------The facility failed to do 1 or more of the following:
- Evaluate resident clinical conditions and risk factors
- Develop and implement interventions consistent with resident needs, goals, and standards of practice
- Monitor and evaluate the impact of interventions
- Revise interventions as needed Determining Noncompliance ---------CORRECT ANSWER-----------------1. Specific action or lack of action relative to requirement
- The pracrice the facility failed to implement
- What the facility did or did not do to cause the noncompliance
- The actual or potential outcome that resulted from the noncompliance.
3 types of contamination ---------CORRECT ANSWER-----------------1. Biological
- Chemical
- Physical What is Critical Control Point (CCP) ---------CORRECT ANSWER-------------- ---a specific point, procedure, or a step in food preparation and serving at which control can be exercised to reduce, eliminate, or prevent the possibility of a food safety hazard. Cooking ,cooling, holding, reheating What foods are Potentially Hazardous Food (PHF) and Time/Temperature Control for Safety (TCS) foods? ---------CORRECT ANSWER-----------------1. Ground Beef
- Poultry
- Fish
- Cut Melon
- Unpasteurized Eggs
- Cottage Cheese How should Potentially Hazardous Foods (PHF) be cooled? --------- CORRECT ANSWER-----------------Cool from 135 degrees to 70 degrees in 2 hours THEN 70 degrees to 41 degrees or lower within 6 hours. At what temperature should hot foods be stored at? ---------CORRECT ANSWER-----------------135 degrees or higher
At what temperature should cold foods be stored at? ---------CORRECT ANSWER-----------------41 degrees or lower At what temperature should food be reheated to? ---------CORRECT ANSWER-----------------165 degrees for 15 seconds within 2 hours Medication Administration Task ---------CORRECT ANSWER-----------------1. Observe 25 opportunities (varity of routes) and facility has an error rate of less than 5%
- Verify residents are free from significant medication errors
- Reconcile observed medications with MD orders
- Professional standards
- Manufacturer specifications
- Verify expiration dates What is a significant medication error? ---------CORRECT ANSWER---------- -------Medication error which causes the resident discomfort or jeopardizes health and safety Environmental Pathway ---------CORRECT ANSWER-----------------1. Accomodation of need
- Call system
- Sound
- Room temperature
- Lighting
- Clean equipment in good repair
- Water temperature
- Bed/bath linens clean and in good condition
- Pest control
- Ventilation
- Handrails
When must a facility notify a Medicaid resident of the amount of money in their account? ---------CORRECT ANSWER-----------------When the account reaches $200 of the eligibility limit. When should QAPI/QAA task be completed? ---------CORRECT ANSWER-- ---------------Towards the end of the survey. End of day meeting discussions ---------CORRECT ANSWER-----------------
- Were offsite concerns validated
- Were new systemic concerns validated
- Has more than 1 surveyor identified and validated the same concern? What does an Extended Survey evaluate? ---------CORRECT ANSWER----- ------------1. Physician Services
- Nursing Services
- Administration
- QAPI
- Infection Control
- Training
- Resident Assessment What is extent? ---------CORRECT ANSWER-----------------Prevalence or fequency What is Universe? ---------CORRECT ANSWER-----------------Total number affected or at risk from deficient practice
Exemestane ---------CORRECT ANSWER-----------------Sublingual Antineoplastic breast cancer medication Zyprexa (Olanzapine) ---------CORRECT ANSWER----------------- Antipsychotic Uses: Schizophrenia, acute agitation, acute manic episodes with bipolar disorders Black box warning: Increased mortality in elderly patients with dementia- related psychosis, postinjection delirium/sedation syndrome. CNS Side effects: EPS (pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia) Neuroleptic malignant Syndrome Nursing considerations: monitor continuously for 3 hours post injection. Haldol (Haloperidol) ---------CORRECT ANSWER-----------------Antipsychotic Uses: Tourette's syndrome, chronic schizophrenia, emergency sedation of severly agitated or delirious patients, ADHD, oppositional defiant disorder Black box warning: Increased mortality in elderly patients with dementia related psychosis CNS Side effects: EPS (pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia), seizures, Neuroleptic malignant syndrome Neuroleptic Malignant Syndrome/Seratonin Syndrome ---------CORRECT ANSWER-----------------Signs/Symptoms: hyperthermia, muscle rigidity, altered mental status, increased CPK, seizures, hypo/hypertension, tachycardia Dishwaher (Heat Disinfection) ---------CORRECT ANSWER----------------- Stationary rack, single temperature machine: 165 Degrees F Stationary rack, dual temperature machine: 150 Degrees F Single tank, conveyor, dual temperature machine:160 DegreesF Multi-tank, conveyor, multi-temp machine: 150 Degrees F Wash: 150-165 Degrees F
Laundry Temperatures ---------CORRECT ANSWER-----------------Hot Water Processing: 160 Degrees F for 25 minutes Low Temperature Processing plus Chlorine or Oxygen Activated Bleach: 71 - 77 Degrees F Weight Loss Calculation ---------CORRECT ANSWER-----------------% of body weight loss = (usual weight - actual weight) / (usual weight) x 100 How long do you have for the generator to start in the event of a power outage for residents on life support? - --------CORRECT ANSWER------------- ----10 seconds Time and temperature required for 3rd degree burns to occur --------- CORRECT ANSWER-----------------155 Degrees F = 1 second 148 Degrees F = 2 seconds 140 Degrees F = 5 seconds 133 Degrees F = 15 seconds 127 Degrees F = 1 minute 124 Degrees F = 3 mnutes 120 Degrees F = 5 minutes 100 Degrees F = Safe bathing temperature What is the max number of residents per room? ---------CORRECT ANSWER----------------- 4 How many residents are needed to require a full time Social Worker for the facilty? ---------CORRECT ANSWER-----------------120 or more
A Life Safety Code Survey ---------CORRECT ANSWER-----------------Must not precede the annual survey Antidepressants ---------CORRECT ANSWER-----------------SSRI's: Prozac, Zoloft, Lexapro SNRI's: Effexor, Cymbalta TCA's: Nortryptline, Amitriptyline MAOI's: Selegeline, Phenelzine Atypical Antidepressants: Wellbutrin, Remeron, Trazodone Mood Stabilizers ---------CORRECT ANSWER-----------------Lithium, depakote, lamictal, carbamazepine, oxcarbazepine Anxiolytics Benzodiazepines and Non-benzodiazepines ---------CORRECT ANSWER-----------------Benzodiazepines: Xanax, Antivan, Valium, Klonipin, Versed Nonbenzodiazepines: Vistaril, Buspirone, Propranolol
