NAB 8

Question 1

A 90-year old lady who is ambulatory is admitted to your facility. About 12 midnight she jumps out of bed and starts walking around. When the CNA
tries to get her back in bed, she Says, “I Can’t stay in bed. I have to walk around for awhile.” What would you suspect her problem is?
1. Insomnia
2. RLS
3. Somnambulism
4. Bad dreams

Answer 1

RLS – Restless Leg Syndrome

RLS - a disorder that causes a strong urge to move your legs. This urge to move often occurs with strange and unpleasant feelings in your legs. Moving your legs relieves the urge and the unpleasant feelings.

People who have RLS describe the unpleasant feelings as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Sometimes, these feelings also occur in the arms.

The urge to move and unpleasant feelings happen when you’re resting and inactive. Thus, they tend to be worse in the evening and at night

Question 2

William Hazard and his associates conducted an extensive study on geriatric
persons. What percent of nursing home residents did they determine suffer
from incontinence?
1. Almost 60 percent
2. Almost 50 percent
3. More than 40 Percent
4. It4ore than 30 percent

Answer 2

1-Almost 60 percent

Question 3

The primary objective of the Medicaid assessment made by the
interdisciplinary team is to determine:
1. the potential for maintaining or improving the five ADL’s.
2. whether the person meets qualifications for admission to the facility.
3. what roommate to assign the new resident to.
4. in which resource utilization group the resident fits.

Answer 3

1. the potential for maintaining or improving the five ADL’s.

Question 4

Restorative Nursing uses Range of Motion (ROM) procedures very frequently. Which of the following is not a PRIMARY RISK factor that causes decreased range of motion?

1. Bedridden
2. Strokes
3. Alzheimer’s disease
4. Loss of vision

Answer 4

4. Loss of Vision

Stokes can often lead to a whole side of a persons body being unusable

Alzheimer’s Disease end of stage often people are just sitting around in wheel chairs.

Question 5

14. What are the procedures found most effective for residents with depression?
15. Spending two or three weeks in a psychiatric program in a hospital
16. Medications, family involvement, and staff attention
17. Counseling, activities, and medications
18. Treatment in a local mental health center

Answer 5

3-Counseling, Activities and medications

Question 6

Mr. Smith gives you a written request for a copy of his medical records on a Friday afternoon. When must you have the copy available for him?

1. Saturday by noon
2. Monday afternoon
3. Tuesday afternoon
4. Within three days of the request

Answer 6

3- Tuesday Afternoon

• ** Resident Rights ***
  (1) To SEE FACILITY has 24 hours (not weekends of Holidays)
  (2) photocopies of all or any portion of the records, at a cost not to exceed the community standard, upon request and 2 workdays advance notice to the facility

Workdays are not SAT or SUN

Question 7

What two areas of training should be mandatory for dietary employees?

1. Food preparation and serving techniques
2. Proper use of equipment and proper portioning of food
3. Food preparation and garbage disposal
4. Safe work techniques and providing a safe environment

Answer 7

4- Safe work techniques and providing a safe environment

Question 8

A facility is required to maintain an emergency drug kit which must be approved by whom?

1. The medical director
2. State Medicaid agency
3. The pharmacist
4. State pharmacy boards

Answer 8

4- State Pharmacy Boards

Question 9

What is the first step in administering a drug?

1. Identify the drug.
2. Review the physician order.
3. Prepare the drug for administration.
4. Identify the resident.

Answer 9

2-Review the physician ORDER

19. 1508 -
    * Drugs to be administered are to be checked against the PHYSICIAN ORDERS

Question 10

How must discontinued drugs be destroyed?
1. Scheduled drugs by a pharmacist
2. Nonscheduled drugs by an RN
3. According to DEA regulations for your district
4 By the DON with a health care professional as witness

Answer 10

3-According to DEA regulations for your district

19.1504 (a) The facility must establish procedures for storing and disposing of drugs and biologicals in accordance with federal, state, and LOCAL LAWS

Question 11

Who is responsible for ensuring that a facility is providing the appropriate resident care?

1. Administrator
2. Medical director
3. Director of nursing
4. Quality assurance committee

Answer 11

2-Medical Director

19.1907-
(b) The medical director is responsible for:
(1) implementation of resident care policies AND
the coordination of medical care in the facility.

Question 12

Surveyors select a sample of residents who have dry skin, cracked lips, poor skin turgor, or fever. What are they looking for?

1. Probability of developing pressure sores
2. Evidence of dehydration from lack of fluids
3. Evidence of poor skin care /
4. Possibility of inadequate diet

Answer 12

2-Evidence of dehydration from lack of fluids

Causes:
•Fever, heat exposure, and too much exercise
•Vomiting, diarrhea, and increased urination due to infection
•Diseases such as diabetes
•The inability to seek appropriate water and food (as in the case of a disabled person)
•An impaired ability to drink (for instance, someone in a coma or on a respirator)
•No access to safe drinking water
•Significant injuries to skin, such as burns or mouth sores, or severe skin diseases or infections (water is lost through the damaged skin

Signs and symptoms: 
•Dry mouth and swollen tongue
•Weakness
•Dizziness
•Palpitations (feeling that the heart is jumping or pounding)
•Confusion
•Sluggishness fainting
•Fainting
•Inability to sweat
•Decreased urine output

*If urine is concentrated and deeply yellow or amber, you may be dehydrated.

Question 13

As a minimum, what should the resident’s admission order include?

1. Level of resident’s functioning in the 5 ADLs
2. A full medical and social history
3. Dietary needs, drugs used, and routine care to maintain resident’s present level of care.
4. Interdisciplinary team’s pre-admission assessment of the resident’s current level of functioning

Answer 13

3-Dietary needs, drugs used, and routine care to maintain resident’s present level of care.

This is True because the PRIMARY GOAL is keeping the RESIDENT ALIVE, this is the MINIMUM.

Question 14

The first step in personnel management is:

1. establishing pay and benefit packages.
2. hiring employees.
3. writing job descriptions for all positions.
4. Developing personnel policies, procedures, and rules.

Answer 14

4-Developing personnel policies, procedures, and rules.

Question 15

The number one priority in OVERALL staff training is:

1. resident care policies and procedures.
2. fire prevention and control.
3. resident rights.
4. prevention and control of infections.

Answer 15

2-Fire Prevention and CONTROL

Question 16

The office of Inspector General strongly encourages nursing home corporations to implement corporate compliance programs The base reason for this is:
1-to ensure that doctors are not accepting enticements for referrals
2-corporations can now be held liable for the criminal acts of its employees.
3-to prevent the intentional and unintentional violation of anti-kickback laws.
4-to educate all employees on their legal responsibilities to comply with laws.

Answer 16

2-corporations can now be held liable for the criminal acts of its employees.

Question 17

What is the first demand that most unions make during their negotiations?
1-A list of all employee names, social security numbers, and home address
2. The latest copy of the facilities balance sheet so they can determine what amount of pay raises are to be expected
3. A copy of the facility benefit package so they determine what new benefits are to be accepted
4. A check off for UNION DUES by which management automatically deducts union dues from paychecks

Answer 17

4. A check off for UNION DUES by which management automatically deducts union dues from paychecks

Question 18

Which of the following billing forms is most often associated with billing for Medicare services?

1. TAD
2. RA
3. UB-92
4. MDS 3.0

Answer 18

3-UB-92

TAD form is a FORM used in LTC that bills MEDICAID
RA -A Remittance Advice (RA) is a document supplied by the insurance payer that provides … quickly identify denials made during initial billing to make necessary corrections
MDS 3.0 is not a BILLING FORM. It is an ASSESSMENT TOOL that connected with RUGS and Reimbursment

Question 19

An administrator discovers soon after accepting a new position that the nursing home is having difficulty paying its bills. In his research he finds that the facility has a severe working capital deficit, despite the fact that
the census is over 90 %. He calls the corporate office to discuss this issue.The CFO advises him that he must increase the working capital so the facility can meet its financial obligations. which of the following is considered the best way to achieve this goal?
1. Pledge the accounts receivable to the bank in order to acquire a Loan.
2. collect the money owed to the facility by working the receivables-.
3. Reduce payroll and eliminate all overtime and agency usage.
4. Increase private pay charges and institute late fees on delinquent payments.

Answer 19

2-Collect the Money owed to the facility by working the RECEIVABLES.

** Working Capital = Current Assesses - Current Liabilities
Recivables are current assists

This account receivable is an asset because it is cash to which the facility is entitled.

Allen MSPH PhD CNHA, James E. (2011-02-25). Nursing Home Administration, Sixth Edition (p. 190). Springer Publishing. Kindle Edition.

Question 20

Which of the following items would an administrator NOT bill for through the facility’s- DURABLE Medical Equipment Regional Carrier?

1. Tube feedings
2. Colostomy supplies
3. Wheel chairs
4. Catheter bags

Answer 20

3-Wheel Chairs
Question should Read. What things are COVERED by the DURABLE Medical Equipment Regional Carrier? The reason he dose not BILL for it is because the REGIONAL CARRIER BILLS Medicare.

** Only Wheel Chair is a Durable Medical Equipment**
Facility Must provide all these supplies (19.2601) but ONLY wheel chair is Durable – Also Durable Med Equip. is a Medicare B Benefit.

Question 21

The chief financial officer of a nursing home company realizes that one of their new acquisitions is not turning around financially as quickly as they had projected. The CFO calls the administrator and requests’ he develop a strategy to help the facility reach a break-even point as quickly as possible. The administrator meets with his staff and they develop their plan. Which of the following would not be a part of their plan to lower the facility’s break-even point?

1. Refinance the monthly debt service
2. Negotiate with facility vendors to get better pricing,
3. Increase the private pay rates to enhance revenue. I 4.convert ovetime to the 8/80 format to reduce payroll taxes.

Answer 21

4- Convert Overtime to the 8/80 format to reduce payroll taxes.

8/80 requires employee participation and a signed document.

You need to know the values of three variables. Those three variables are fixed costs, variable costs, and the price of the product.

Fixed Costs/Price - Variable Costs = Breakeven Point in Units

Question 22

The Wage and Hour Division requires employers maintain accurate payroll and time records. Which of the following time frames are most reflective of Wage and Hour policies?

1. Time records must be kept a minimum of 2 years and payroll records kept for 3 years.
2. All time records and payroll records must be kept a minimum of 3 years.
3. Time records must be kept a minimum of 3 years and payroll records kept for 4 years.
4. All payroll records are kept for a minimum of 5 years unless the individual states have more stringent requirements

Answer 22

1. Time records must be kept a minimum of 2 years and payroll records kept for three years.

• IRS requires 2 years of TIME sheets 3 years of Payroll.
  http: //www.qbalance.com/Record_retention.htm

5 years is many of the other retention periods involving nursing homes See: 19.1910

Question 23

You purchase a new state-of-the arts laundry system for your Medicare/Medicaid nursing home. In your research you find that this system will save you $1600 a year in utilities and will decrease staffing. The cost of the
equipment is $10,000. The estimated value of the equipment at the end of its depreciable life is $2000. What is the payback period?
1. 5.5 years
2. 6.25 years
3. 8.75 years
4. 10 years

Answer 23

2- 6.25 Years

Payback _ the amount of $$ you spent, vs how long it will take you to break even.

If you SAVE $1600 a year it will take you 6.25 years to get back to $10000. 1600*6.25 = 10000 OR 10000/1600 = 6.25 years

Question 24

The purchase price for a new kitchen stove is $12,000. It will have a depreciable life of 10 years and will have a salvage value of $1500 at the end of that time frame. Using the Medicare depreciation schedule, calculate the accumulated depreciation at the end of 7 years.

1. $1,714
2. $7,350
3. $7,630
4. $8,400

Answer 24

2- $7350

1200 COST - 1500 Salvage = 10500,
10500/(10 years) = 1050 per year of depreciation

Year 7 is 1050*7 = $7350

OR 12000-(10X) = 1500: Solve for X and Multiply by 7