Nursing Home Administration Exam! Hardest Trivia Questions Quiz

164 Questions | Total Attempts: 13

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Nursing Home Administration Exam! Hardest Trivia Questions Quiz

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Questions and Answers
  • 1. 
    If a nursing facility has been certified by Medicare and Medicaid under Final Rules and federal requirements, in effect, it ___.
    • A. 

      Can be exempted from state and local licensure requirements

    • B. 

      Must still meet all state and local licensure requirements

    • C. 

      Is deemed to have met all state and local licensure requirements

    • D. 

      May apply for a waiver from state requirements

  • 2. 
    Establishing and implementing policies regarding the management of the facility is assigned to ___.
    • A. 

      The Administrator

    • B. 

      The owner(s)

    • C. 

      The governing body or persons designated as such

    • D. 

      The facility staff

  • 3. 
    In order to begin collecting better data about the nursing home industry, federal legislation mandated development and use of ___.
    • A. 

      The Comprehensive Care Approach

    • B. 

      A Minimum Data Set

    • C. 

      Changes in record keeping

    • D. 

      A state-developed data collection

  • 4. 
    The comprehensive care plan does not include a/an ___.
    • A. 

      Attending physician

    • B. 

      Registered nurse caregiver

    • C. 

      Resident

    • D. 

      Medical Director

  • 5. 
    If a nursing facility has been certified by Medicare and Medicaid under Final Rules and federal requirements, in effect, it ___.
    • A. 

      Can by exempted from state and local licensure requirements

    • B. 

      Must still meet all state and local licensure requirements

    • C. 

      Is deemed to have met all state and local licensure requirements

    • D. 

      May apply for a waiver from state requirements

  • 6. 
    Establishing and implementing policies regarding the management of the facility is assigned to ___.
    • A. 

      The Administrator

    • B. 

      The owner(s)

    • C. 

      The governing body or persons designated as such

    • D. 

      The facility staff

  • 7. 
    Nurse aides who have completed a training and competency evaluation program and passed the required competency test(s) ___.
    • A. 

      May serve at any facility

    • B. 

      Must still be judged by surveyors as competent to provide services

    • C. 

      May, at their opinion, be registered with the state nurses aide registry

    • D. 

      May sit for training for nurses aide assistant, IV

  • 8. 
    Responsibility for ascertaining professional performance standards for licensed, certified, or registered allied health persons used by the facility rests with the ___.
    • A. 

      Respective certifying or registering boards

    • B. 

      Resident or her responsible party

    • C. 

      State

    • D. 

      Facility

  • 9. 
    Organizations that actually pay the Medicare claims submitted by doctors and other medical suppliers are called ___.
    • A. 

      Carriers

    • B. 

      Medicare contractors

    • C. 

      Third-party payers

    • D. 

      Intermediaries

  • 10. 
    The facility is not required to use its resource effectively and efficiently to attain highest practical ___.
    • A. 

      Resident physical well being

    • B. 

      Resident mental well being

    • C. 

      Profitability

    • D. 

      Resident psychosocial well being

  • 11. 
    A person who is determined by the state mental health authority to need nursing facility service but is receiving active treatment for mental illness ___.
    • A. 

      Can be admitted

    • B. 

      Must not be admitted

    • C. 

      May be admitted if the medical director authorizes it

    • D. 

      Must go to the state mental hospital or equivalent

  • 12. 
    Each facility must designate a physician to serve as medical director ___.
    • A. 

      On a part-time basis

    • B. 

      On a full-time basis

    • C. 

      On a part- or full-time basis

    • D. 

      When needed

  • 13. 
    The administrator believes that once his obligation to meet federal, state, and local laws is met, he has satisfied the requirements applicable to the operation of his facility.  The administrator is ___.
    • A. 

      Following all requirements

    • B. 

      By definition meeting standards

    • C. 

      Exceeding minimum operational standards

    • D. 

      Only partially correct

  • 14. 
    Having a transfer agreement with one or more hospitals is ___.
    • A. 

      Good practice

    • B. 

      A risk management measure

    • C. 

      A condition of participation requirement

    • D. 

      Wise step-in preparation for emergency situations

  • 15. 
    Nursing homes are licensed by ___.
    • A. 

      The counties

    • B. 

      The states

    • C. 

      The federal regional government arms

    • D. 

      Centers for Medicare and Medicaid

  • 16. 
    Regulations such as those implementing Medicare and Medicaid; Requirements for Long-term Care Facilities, are first published in the ___.
    • A. 

      U.S. Code

    • B. 

      National Register

    • C. 

      Congressional Record

    • D. 

      Federal Register

  • 17. 
    All facilities are required to ___.
    • A. 

      Have a governing body

    • B. 

      Have an adequately functioning administrator who reports to a corporate board

    • C. 

      Have a governing body or designated persons

    • D. 

      Have a governing body or designated persons functioning as a governing body

  • 18. 
    The facility administrator establishes written transfer agreements with two local hospitals, one of which is approved only for participation under the medicare program, and the second approved only for participation under Medicaid.  The administrator has ___.
    • A. 

      Failed to meet transfer agreement requirements

    • B. 

      Accomplished the minimum required by the Federal Regulations

    • C. 

      More than met the minimum required - an agreement with one of these hospitals would meet requirements

    • D. 

      Assured that needed transfers can be accomplished

  • 19. 
    The transfer agreements signed by the administrator assure that Medical and other information needed for care and treatment of residents, and guarantees that a bed will be available for the resident upon his return from the hospital.  This is the entire agreement.  A visiting surveyor would ___.
    • A. 

      Find this acceptable

    • B. 

      Require changes to the transfer agreement

    • C. 

      Believe residents of that facility were being adequately protected

    • D. 

      Feel comfortable that a resident's right to return to the facility has been protected.

  • 20. 
    The terms for Medicare and Medicaid participating homes used in the Final Rules effect are ___.
    • A. 

      Nursing home and nursing facility

    • B. 

      Medicaid facility and Medicare facility

    • C. 

      Skilled nursing facility and nursing facility

    • D. 

      Approved facility and licensed facility

  • 21. 
    The discharge social worker at the hospital determines that the resident cared for under the transfer agreement should return, not to the facility, but by placed in an assisted living facility that is a less expensive setting.  Normally, ___.
    • A. 

      This is inappropriate

    • B. 

      This is appropriate

    • C. 

      This is outside the prerogative of a hospital

    • D. 

      This is frowned upon by Medicare

  • 22. 
    If persons with controlling interest in the facility, the company owning the facility or the administrator or director of nursing change, the facility should ____.
    • A. 

      Call and inform the state facility licensing agency

    • B. 

      Inform the state licensing agency in writing

    • C. 

      Inform the Medicare Intermediary

    • D. 

      Inform the state Medicaid officials

  • 23. 
    The administrator decides the trained therapeutic recreation specialist is too costly for the facility and hires, instead, a less expensive qualified occupational therapy assistant.  This is ___.
    • A. 

      Within the federal hiring guidelines

    • B. 

      Outside the federal hiring guidelines

    • C. 

      An unfortunate decision

    • D. 

      Likely to not be a cost effective decision

  • 24. 
    The recently graduated social worker job applicant for a 140-bed facility states she has a bachelor's degree in psychology and one year's experience as supervisor of four social workers at a nearby nursing hospital.  The administrator should ___.
    • A. 

      Be satisfied that the applicant meets requirements for his facility

    • B. 

      Hire the applicant

    • C. 

      Explore the applicant's experience in more depth

    • D. 

      Be please that the applicant has supervised four social workers

  • 25. 
    The administrator of a 50-bed facility asks the director of nursing to serve as both director of nursing and as a charge nurse on the weekend shift.
    • A. 

      This is appropriate

    • B. 

      Minimum staffing has been met

    • C. 

      Minimum staffing has not been met

    • D. 

      Not permitted

  • 26. 
    If a facility provides the stated minimum number of hours per resident day of care, a state or federal inspector ____.
    • A. 

      May still cite nursing for insufficient staffing

    • B. 

      Will pass the facility on staffing

    • C. 

      Will require the facility to maintain that ratio

    • D. 

      May, at her discretion , reduce the staffing required

  • 27. 
    If the administrator of an average daily total occupancy of 80 residents requires the director of nursing to serve as charge nurse, the administrator ___.
    • A. 

      Has met Final Rules requirements

    • B. 

      Needs to routinely report the assignment to the State

    • C. 

      Has failed to meet Final Rules requirements

    • D. 

      Has exceeded Final Rules requirements

  • 28. 
    The consultant pharmacist at his monthly visit requires the director of nursing to provide to him a reconciliation report for all controlled drugs signed verified by the director of nursing. The pharmacist ___.
    • A. 

      Has met his obligations

    • B. 

      Has acted in good faith

    • C. 

      Should determine himself that drug records are in order

    • D. 

      Is meeting the expectations of Medicare and Medicaid record keeping

  • 29. 
    The personnel director recommends a part-time nurses aide who has worked at the facility for the past six months and is nearing the end of her competency evaluation program.  The administrator should feel that the personnel director is ___.
    • A. 

      Doing a good job

    • B. 

      Not understanding the requirements

    • C. 

      Smart to have a person under observation for six months before permanent hiring

    • D. 

      Functioning quite well

  • 30. 
    At least every 12 months, the facility requires all full- and part-time nurses aides to fill in a report on his/her continuing education done by each aide in the facility.  This report is then filed in the employee's personnel file.  The facility is ___.
    • A. 

      Meeting reporting requirements

    • B. 

      Right to keep the signed report in the employee's personnel file

    • C. 

      Not keeping adequate records of training

    • D. 

      Failing to train based on outcome of these reviews

  • 31. 
    When the facility does not employ a qualified professional to furnish a service to be provided by the facility, the facility ___.
    • A. 

      Can provide a list of suitably qualified professionals in the community

    • B. 

      Can seek volunteer help for unmet services

    • C. 

      Must use the local hospital

    • D. 

      Must have that service furnished

  • 32. 
    The facility should train all employees in emergency procedures ____.
    • A. 

      By the end of the first week on the job

    • B. 

      The first day on the job

    • C. 

      As soon as training staff are available

    • D. 

      Before the employee's first day on the job

  • 33. 
    The facility must train ___ in emergency procedures ___.
    • A. 

      All caregiver employees/when they begin to work

    • B. 

      All employees/when they begin to work

    • C. 

      Designated employees/within three weeks of employment

    • D. 

      New employees/within one week

  • 34. 
    When a facility learns a court of law has taken action against one of its employees, indicating unfitness for service, the facility must ___.
    • A. 

      Fire that employee immediately

    • B. 

      Give thee employee two weeks' notice

    • C. 

      Require additional inservice education for that employee

    • D. 

      Report the court's action to licensing authorities

  • 35. 
    Ms. Brown alleges for the twelfth documented time that she was abused by an employee.  The facility ___.
    • A. 

      Is justified in the documenting, but not investigating the matter

    • B. 

      Is negligent in protecting patients

    • C. 

      Should counsel with the resident

    • D. 

      Should consider transferring the resident to a more suitable facility

  • 36. 
    If the facility does not employee a full-time qualified dietitian, the facility ___.
    • A. 

      Can appoint instead a full-time director of food services

    • B. 

      May seek consultation from the outside

    • C. 

      Designates a director of food services who receives consultation from a qualified dietitian

    • D. 

      Employees a nutrition expert who advises the director of food services

  • 37. 
    The facility must employee a ___ either full-time, part-time, or on a consultant basis.
    • A. 

      Director of food services

    • B. 

      Chef

    • C. 

      Sufficient dietary staff

    • D. 

      Qualified dietitan

  • 38. 
    Orders for routine care or to improve the resident's functional abilities must be available ___.
    • A. 

      At admission

    • B. 

      Within 24 hours of admission

    • C. 

      Within 36 hours of admission

    • D. 

      By the second shift after readmission

  • 39. 
    If mental health rehabilitative services for mental illness or mental retardation are required in the resident's plan of care, the facility ___.
    • A. 

      May seek to transfer the resident to a mental health services setting

    • B. 

      Must transfer the resident to a mental health services setting

    • C. 

      Must provide such services in house

    • D. 

      Must provide in house or obtain such services

  • 40. 
    The care plan team determines that, although they had not anticipated it, the resident needs physical therapy.  The facility should ___.
    • A. 

      Assign the therapy to a qualified physical therapist either in house or from outside

    • B. 

      Get a physician's written order

    • C. 

      Get authorization from the Medicare provider

    • D. 

      Begin the physical therapy as soon as possible

  • 41. 
    A resident who has been determined by the courts to be incompetent decides he no longer wants the court appointed representative to handle his personal funds and asks the facility to establish a personal funds account for him.  The facility should ___.
    • A. 

      Establish a personal funds account for that resident

    • B. 

      Seek the advice of an attorney

    • C. 

      Ask the court appointed representative for permission to establish an account

    • D. 

      Get the advice of the facility accountant

  • 42. 
    Perhaps the most basic purpose of the new management of personal resident funds rules is to ___.
    • A. 

      Reduce resident confusion about finanances

    • B. 

      Improve facility accounting efficiency

    • C. 

      Improve interest rates to residents by pooling resident funds

    • D. 

      Avoid commingling resident funds with facility funds

  • 43. 
    Notifying ___ residents when their account reaches ___ less than the ___ resource limit for one person is required.
    • A. 

      Medicare/$200/SSI

    • B. 

      Medicaid/$300/SSA

    • C. 

      Medicaid/$200/SSI

    • D. 

      All/$200/personal funds

  • 44. 
    Upon discovering that the new intake social worker required the individual holding durable power of attorney for the patient's funds to sign a contract guaranteeing payment from that patient's funds, the administrator should ___.
    • A. 

      Discourage the social worker from finding similar admissions

    • B. 

      Revoke the guarantee of payment document

    • C. 

      Discipline the social worker

    • D. 

      Praise the intake social worker

  • 45. 
    Rights of residents who are adjudged incompetent by a court are exercised by ___.
    • A. 

      The locally appointed ombudsman

    • B. 

      The family

    • C. 

      A person appointed by the court

    • D. 

      The responsible adult

  • 46. 
    Under the Final Rules, right to immediate access to any resident by representatives of the State, ombudsman, protection agencies, and advocacy agencies is ___.
    • A. 

      Subject to resident approval

    • B. 

      Unrestricted

    • C. 

      Carefully set out as to time and place

    • D. 

      Subject to facility approval

  • 47. 
    A representative of the state ombudsman office demands to see the clinical record of a Medicaid resident who had written he wanted no one to have access to his clinical record.  Upon receiving the request, you, the administrator, should ___.
    • A. 

      Deny permission to the ombudsman

    • B. 

      Provide access to the record requested by the ombudsman

    • C. 

      Tell the ombudsman you will seek legal counsel, then respond

    • D. 

      Ask the ombudsman to return at a later time

  • 48. 
    The resident hangs a religious ornament above his bed.  Several nurse aides are offended and feel it is inappropriate.  The facility administrator should ___.
    • A. 

      Seek a resident council opinion

    • B. 

      Advise the aides that this is appropriate

    • C. 

      Try to enforce the separation of church and state rules

    • D. 

      Get the facility attorney involved

  • 49. 
    A resident may refuse to release personal and clinical records when ___.
    • A. 

      Transferred to another health care facility

    • B. 

      Third-party payment contracts seek it

    • C. 

      Required by law

    • D. 

      Required by the duly appointed state ombudsman

  • 50. 
    A resident asks the afternoon nurse on duty to access his patient records.  The nurse responds that she will have the records by made available by late tomorrow morning.  The nurse's response is ___.
    • A. 

      A denial of resident rights

    • B. 

      Appropriate

    • C. 

      An unpermitted delay

    • D. 

      Clearly a delaying tactic

  • 51. 
    Congress intends that residents have the right to inspect, upon 48 hours notice, ___.
    • A. 

      Their medical record

    • B. 

      The plan of care

    • C. 

      Medication records

    • D. 

      All their records

  • 52. 
    A resident is concerned about her cognitive status and asks to see all the facility has in her records about her cognitive status, including tests administered at admission four weeks earlier.  The resident is ___.
    • A. 

      Unnecessarily worried

    • B. 

      Inappropriate

    • C. 

      Asking for information the facility should withhold

    • D. 

      Within her rights

  • 53. 
    The new resident speaks only Japanese.  Before the resident was admitted, the facility advised her through her interpreter that no one in the facility spoke Japanese and that solely sign language would be used.  Upon examining this admission condition in the resident's records, the surveyor would ___.
    • A. 

      Feel the facility had made a reasonable choice

    • B. 

      Ask to see the signage to assess its adequacy

    • C. 

      Cite the facility

    • D. 

      Suggest ways the facility might better communicate with this resident

  • 54. 
    After the first of 10 scheduled physical therapy sessions following his surgery, the resident tells the physical therapist he is not going to keep the final 9 appointments.  The resident is ___.
    • A. 

      Making a foolish decision

    • B. 

      Exceeding his rights to control his health care

    • C. 

      Within his rights

    • D. 

      Making a questionable decision

  • 55. 
    The resident decides to discontinue all the 9 drugs being administered daily.  The facility staff feel this may result in a coma likely followed by death.  The facility ___.
    • A. 

      Can modify this decision as needed to keep the resident alive

    • B. 

      Must comply and maintain resident at highest level within that decision

    • C. 

      Must contact and follow the physician's orders

    • D. 

      Should consider transferring the resident

  • 56. 
    Informing a resident of his rights is required ___.
    • A. 

      Within 24 hours of admission

    • B. 

      Prior to admission

    • C. 

      Prior to or at admission

    • D. 

      As a courtesy to each entering resident

  • 57. 
    A resident may perform services for the facility if the services are ___.
    • A. 

      Voluntary

    • B. 

      Paid at or above prevailing rates

    • C. 

      In the plan of care

    • D. 

      Light duty in nature

  • 58. 
    When the physician decides to discontinue an existing form of treatment due to adverse consequences, the facility ___.
    • A. 

      Must note this in the resident's care plan

    • B. 

      Must notify the resident and the resident's representative

    • C. 

      Inform the pharmacy of this new information

    • D. 

      Order new replacement drugs

  • 59. 
    The facility staff suspect family members are abusing a resident's funds and requires that for the resident's protection his funds must be deposited with the facility.  This is ___.
    • A. 

      A prudent step for the facility

    • B. 

      Not permitted

    • C. 

      Subject to review by the owners

    • D. 

      A routine protection afforded residents by most facilities

  • 60. 
    A resident routinely maintained $40 in his personal funds account and is upset to learn the facility has his funds in a non-interest bearing account.  Placing this resident's funds in a non-interest bearing account is ___.
    • A. 

      Permitted

    • B. 

      Required

    • C. 

      Optional if the resident agrees

    • D. 

      Expected financial behavior

  • 61. 
    A facility that informs each resident who is entitled to Medicaid benefits, in writing, at admission, and when changes occur of services which are paid for under the State plan has ____.
    • A. 

      Met its obligations

    • B. 

      Exceeded its required information

    • C. 

      Not fully met its notice of service obligations

    • D. 

      Properly interpreted the Final Rules requirement to inform

  • 62. 
    Upon the death of a Medicaid resident, the facility conveyed the resident's funds within 14 days and promised to forward a final accounting in three weeks.  This is ___.
    • A. 

      Within the required notification periods

    • B. 

      A failure to meet notification requirements

    • C. 

      Faster refunding and accounting than required

    • D. 

      Meeting minimum standards

  • 63. 
    As part of a larger chain, the local facility believes that self-insurance plus use of Federal deposit Insurance Corporation insured accounts is a reasonable protection of resident funds.  The surveyor is likely ___.
    • A. 

      To agree

    • B. 

      To want to assure financial stability by reviewing the balance sheets for the facility

    • C. 

      To issue a deficiency

    • D. 

      Examine the facility's financial track record

  • 64. 
    The facility routinely charges all cosmetic and grooming items and services for private, Medicare, and Medicaid residents.  This charging policy ___.
    • A. 

      Is permitted at facility discretion

    • B. 

      Meets Medicare rules, but not Medicaid rules

    • C. 

      Meets all rules

    • D. 

      Is not permitted for Medicare and Medicaid residents

  • 65. 
    The facility proudly installed flat screen TVs in all resident rooms and added a small surcharge to all residents' monthly charges.  This freed up significant floor space in each room and improved resident morale.  This approach to improving resident life ___.
    • A. 

      Is appropriate

    • B. 

      Violates Medicare and Medicaid rules

    • C. 

      Meets Medicare rules but not those of Medicaid

    • D. 

      Meets Medicaid, but not Medicare rules

  • 66. 
    The resident reports the facility to the State for releasing his medical records to the local hospital.  Despite his refusal to release these records when he was transferred to the local hospital.  The State is likely to ___.
    • A. 

      Issue a fine

    • B. 

      Inform the resident he has no right to refuse to release his records upon transfer

    • C. 

      Issue a citation

    • D. 

      Assure the resident it will not happen again

  • 67. 
    Te resident has complained numerous times about the disruptive behavior of a nearby resident.  The facility assures the resident there is noting that can be done.  This is ___.
    • A. 

      Probably an accurate statement by the facility

    • B. 

      An inadequate facility response

    • C. 

      A routine occurrence

    • D. 

      Not addressed by Federal rules

  • 68. 
    A resident demands to see both the most recent survey results and the plan of correction.  The facility shows the survey results but tells the resident that the plan of correction is confidential and not available.  The facility is ___.
    • A. 

      Within its rights

    • B. 

      Violating resident rights

    • C. 

      Acting prudently

    • D. 

      Protecting sensitive information

  • 69. 
    The resident , upon his request, requested work delivering newspapers throughout the facility.  This is an approved part of the resident's care plan.  The resident receives $5.00 and hour for his work.  The facility is ___.
    • A. 

      Meeting work requirements

    • B. 

      Not meeting work requirements

    • C. 

      Improperly documenting the resident's work

    • D. 

      Appropriately humoring the resident

  • 70. 
    The resident demands computer and internet access, but the facility fails to provide this.  The facility ___.
    • A. 

      Is within its rights

    • B. 

      Is failing to meet requirements

    • C. 

      Is behind the times

    • D. 

      Is worried about resident privacy

  • 71. 
    A representative of the Secretary knocks on the locked front door at 5:30am and wants immediate admission.  The charge nurse tells the representative to wait until the facility opens at 6:00am.  This is ___.
    • A. 

      Within the facility's discretion

    • B. 

      Good judgment

    • C. 

      A safety and risk management behavior

    • D. 

      A violation

  • 72. 
    The administrator refuses to permit a large piece of furniture to be placed in the resident's room arguing that it overly obstructs movement.  The administrator is ___.
    • A. 

      Within his rights

    • B. 

      Ignoring resident rights

    • C. 

      Making his own rules without regard to the resident

    • D. 

      Making a mistake

  • 73. 
    Consenting married residents have a right to share a room ____.
    • A. 

      Regardless of their health conditions

    • B. 

      If facility policy permits

    • C. 

      When a room is conveniently available

    • D. 

      When approved by the resident council

  • 74. 
    An individual resident can self -administer his drugs if ___.
    • A. 

      The pharmacy approves

    • B. 

      The attending physician approves

    • C. 

      The interdisciplinary team has determined this is safe

    • D. 

      The resident accepts responsibility for storing the drugs safely

  • 75. 
    The facility may transfer a resident ___.
    • A. 

      When beds are scarce

    • B. 

      When the resident is a month late in payment of charges

    • C. 

      If the facility will close within one year

    • D. 

      If the resident is persistently disruptive to other patients comforts

  • 76. 
    The facility seeking to transfer a resident must ___.
    • A. 

      Record the reasons in the resident's clinical record

    • B. 

      Give 90 days' notice

    • C. 

      Have a good reason

    • D. 

      Need the bed for other residents who seek to return from the hospital

  • 77. 
    When a facility notifies a resident of transfer on February 1, to be accomplished March 1, the facility has ___.
    • A. 

      Met Final Rules requirements

    • B. 

      Failed to meet Final Rules requirements

    • C. 

      Taken appropriate action when unable to meet needs

    • D. 

      Acted in good faith

  • 78. 
    When the nurse gives complete verbal notice of the duration of the bed-hold policy under the State plan to a resident and his family before transfer to a hospital, the facility can be said to have ___.
    • A. 

      Met Final Rules requirements

    • B. 

      Failed to meet Final Rules requirements

    • C. 

      Exceeded Final Rules requirements

    • D. 

      Conformed acceptably to Final Rules requirements

  • 79. 
    Regarding group or family meetings, after providing space and privacy to resident families and any persons they invite in, the facility obligations are ___.
    • A. 

      Met

    • B. 

      Partially met

    • C. 

      Exceeded

    • D. 

      Optional as to further assistance

  • 80. 
    The facility is by policy a 100% private pay residents facility.  The facility informs prospective residents both in writing and orally in a language they can understand.  This ___.
    • A. 

      Meets the facility's obligations

    • B. 

      Is permitted under special circumstances in some Medicare certified facilities

    • C. 

      Is not permitted

    • D. 

      Is a safe business practice

  • 81. 
    The facility requires only private paying patients to designate a third party who will pay the bills.  Medicare and Medicaid patients are billed only from their own funds.  This ____.
    • A. 

      Is a correct interpretation of the rules

    • B. 

      Is a necessary business practice

    • C. 

      Assures a good collection rate

    • D. 

      Violates Medicare and Medicaid standards

  • 82. 
    The new administrator announces that after two weeks no restraints will be allowed, even those required to meet the residents' medical symptoms.  This is ___.
    • A. 

      Permitted

    • B. 

      Not permitted

    • C. 

      A violation of Federal rules

    • D. 

      A mis-interpretation of the rules' intent

  • 83. 
    To lessen the risk incidents of resident abusive treatment of other residents, the facility permits Mr. Jones to remain in his room throughout the day.  This is ___.
    • A. 

      Good risk management

    • B. 

      Within the intent of the Federal rules

    • C. 

      Abusive treatment

    • D. 

      A good way to reduce incidents of residents abusing other residents

  • 84. 
    The administrator who learns that the director of nurses obtained physician's orders for physical restraints on three "too time-consuming "wander" residents should ___.
    • A. 

      Compliment the DON on solving a staffing problem

    • B. 

      Seek the same for additional residents

    • C. 

      Ask the physicians to remove the restraint orders

    • D. 

      Continue about her normal daily duties

  • 85. 
    An alleged violation of neglect of a resident has been lodged.  The administrator has reported this to the state, conducted an investigation the next day, and concluded no violation occurred.  The administrator should ___.
    • A. 

      Report results to state officials within 5 days of the alleged violation

    • B. 

      Document the investigation results and file it for state review at annual inspection time

    • C. 

      Reprimand the employee involved

    • D. 

      Consider the matter successfully settled

  • 86. 
    The facility sets up mechanisms to listen to the views and record grievances and recommendations of residents and families concerning proposed policy.  The facility has ___.
    • A. 

      Met expectations under the Federal regulation

    • B. 

      Exceeded what it is required to do

    • C. 

      Failed to meet regulations

    • D. 

      Set up a good feedback mechanism

  • 87. 
    A uniform data set describing the resident's capability to perform daily life functions and functional impairments is known as ___.
    • A. 

      The uniform (minimum) (comprehensive) data set

    • B. 

      Comprehensive care plan

    • C. 

      Resident needs assessment

    • D. 

      Resident data assessment card

  • 88. 
    Resident assessments must be conducted within ___ days after admission, after a significant mental or physical change, at least every ___ months.
    • A. 

      6 8

    • B. 

      4 6

    • C. 

      14 12

    • D. 

      4 24

  • 89. 
    The resident assessment must be conducted or at least coordinated by and signed by ___.
    • A. 

      The resident's physician

    • B. 

      The medical director or resident's physician

    • C. 

      A registered nurse

    • D. 

      The director of nursing

  • 90. 
    A resident enters a facility continent.  Due to new clinical conditions, catherization becomes necessary.  The facility's entire response is to provide services "to prevent urinary tract infections" and treat them if occurring.  The facility has ___.
    • A. 

      Met Final Rules standards

    • B. 

      Failed to meet Final Rules standards

    • C. 

      Exceeded what is required under Final Rules

    • D. 

      Performed good quality care

  • 91. 
    A resident's clinical condition demonstrates that a nasogastric tube is unavoidable.  The facility documents this and begins a permanent program designed to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharngeal ulcers.  A Medicare inspector would consider the facility to have ___.
    • A. 

      Met Final Rules requirements

    • B. 

      Exceeded Final Rules requirements

    • C. 

      Given excellent care

    • D. 

      Failed to implement the intent and spirit of Final Rules

  • 92. 
    To accommodate a resident returning from the hospital, the facility informs Mrs. Brown that in half an hour the staff will be moving in a new roommate.  The facility ___.
    • A. 

      Is making the right decision

    • B. 

      Has the right to make such needed changes

    • C. 

      Is meeting its obligations to residents

    • D. 

      Is failing to meet its obligations to residents

  • 93. 
    The facility appoints the director of nursing, the medical director's Physician Assistant, and four additional staff members to serve on the Quality Assessment and Assurance Committee.  This ___.
    • A. 

      Meets requirements

    • B. 

      Exceeds requirements

    • C. 

      Is optional for the facility under the new guidelines

    • D. 

      Fails to satisfy the Federal guidelines

  • 94. 
    The Quality Assessment and Assurance Committee chair informs the administrator that the committee meets every four months and has developed and implemented appropriate plans of action.  The administrator should ___.
    • A. 

      Be pleased

    • B. 

      Review the written reports of this committee

    • C. 

      Be concerned

    • D. 

      Thank the chair

  • 95. 
    During a Medicare survey, the director of nursing refuses to disclose the records of the Quality Assessment and Assurance Committee to enable the surveyor to review the actions taken.  The director of nursing is ___.
    • A. 

      Within her rights

    • B. 

      Acting foolishly

    • C. 

      Likely to cause an unnecessary deficiency to be given

    • D. 

      Using poor judgment

  • 96. 
    The facility identifies low potassium as a nutritional problem, provides a therapeutic diet to correct the potassium deficiency.  The resident refuses the therapeutic diet and insists she wishes to eat a regular diet just like the other residents around her.  The facility should ___.
    • A. 

      Serve the therapeutic diet

    • B. 

      Serve an enriched diet

    • C. 

      Serve a regular diet

    • D. 

      Have the resident's attending physician explain why the therapeutic diet is necessary

  • 97. 
    In January, Mrs. Green weighed 112 pounds.  In June, she weighed 98 pounds.  This is ___.
    • A. 

      Within normal weight expectations

    • B. 

      A significant weight loss

    • C. 

      A predictable weight loss

    • D. 

      A severe weight loss

  • 98. 
    Mrs. Gray refused to eat the meat served for lunch.  The facility offered Mrs. Gray a second salad.  This is ___.
    • A. 

      Within the rules

    • B. 

      Appropriate

    • C. 

      Inappropriate

    • D. 

      Using good judgment since Mrs. Gray is known to especially like salads

  • 99. 
    The registered dietitian prescribes a therapeutic diet for Mrs. Blue because the dietitian noticed some weight loss in the past two months.  As lunch was about to be served anyway, the kitchen staff was able to implement the new diet within 10 minutes of the nutritionist's recommendation.  The administrator should ___.
    • A. 

      Feel his staff is really agile

    • B. 

      Meet with the dietitian

    • C. 

      Use this as an example of quick work at the next staff meeting

    • D. 

      Turn his attention to more pressing matters

  • 100. 
    During the periodic mid-afternoon visit, the consultant dietitian writes out therapeutic diets for the four new residents and hands them individually, as soon as she writes them, to the director of food services for preparing food for those residents that evening.  Upon being informed of this that afternoon, the administrator should ___.
    • A. 

      Thank the dietitian for such fast turnaround

    • B. 

      Check the diets prescribed by the dietitian against the recommended nutritional needs in the Final Rules requirements

    • C. 

      Tell the director of food services to serve regular diets to those four new residents that night

    • D. 

      Permit the director of food service 2 days to implement the therapeutic diets

  • 101. 
    Snacks at bedtime ___.
    • A. 

      May be offered to competent residents

    • B. 

      Must be offered to all residents

    • C. 

      Must be nutritional if offered

    • D. 

      Must meet Final Rules specified nutritional values

  • 102. 
    The air conditioning roof unit fan shaft has run dry and required quick oiling for several months.  The facility is ___.
    • A. 

      Due for a new roof unit

    • B. 

      Being economical

    • C. 

      Practicing just in time repair

    • D. 

      Failing to do preventative maintenance

  • 103. 
    A facility initially certified under Final Rules, which at the request of the resident council, maintains a winter temperature of 83 degrees despite protests from staff that this is too hot for the staff is ___.
    • A. 

      Complying with Final Rules directives

    • B. 

      Not in noncompliance with Final Rules

    • C. 

      Correctly responding to resident directives

    • D. 

      Voluntarily exceeding the need to acceptably meet resident needs

  • 104. 
    The resident has mentioned to the administrator several times that he is tired of waiting for a room with a window to the outside.  The facility is ___.
    • A. 

      Failing to meet physical building requirements

    • B. 

      Justified if no other rooms are available

    • C. 

      Not doing enough to meet expectations of residents

    • D. 

      Needing better policies on meeting resident room preferences

  • 105. 
    Each resident room must have ___.
    • A. 

      A full bath

    • B. 

      125 square feet per resident

    • C. 

      Its own fire extinguishment system

    • D. 

      At least one window to the outside

  • 106. 
    The call systems representative's recommendations for installing a call system to the bathing facilities in addition to the present resident room and toilets call systems were turned down by the administrator as too expensive.  This ____.
    • A. 

      Is the administrator's prerogative

    • B. 

      Is reasonable in light of reimbursement levels

    • C. 

      Meets enough requirements without the additional call system

    • D. 

      Is not meeting standards

  • 107. 
    The facility has an infection control program that has effectively investigated and controlled every infectious outbreak.  When the state visits and evaluates this program the state will likely ___.
    • A. 

      Be pleased

    • B. 

      See this an example to be recommended

    • C. 

      Issue a deficiency

    • D. 

      Ask about how this has been so successfully accomplished

  • 108. 
    Such details as size of committee, scope of work, and reporting requirements for the infection control function are ___.
    • A. 

      Carefully described in Final Rules

    • B. 

      Left to the facility

    • C. 

      Left to the individual states to specify

    • D. 

      Recommended by not required under Final Rules

  • 109. 
    Maintaining a record of incidents and corrective actions related to infections is assigned under Final Rules to ___.
    • A. 

      The nursing department

    • B. 

      The medical director

    • C. 

      The infection control program

    • D. 

      A mandated quality control coordinator

  • 110. 
    The general approach of the Federal Requirements is to state federal requirements, for example, infection control, and budgets required, ___.
    • A. 

      In general (less specific or detailed) terms

    • B. 

      In great detail

    • C. 

      To achieve closer control

    • D. 

      To insure identical policies facility to facility

  • 111. 
    The nurse was miffed that she could not get a medical decision until the attending physician was to return from a medical convention and mentions this to the administrator.  The administrator should ___.
    • A. 

      Meet immediately with the director of nursing

    • B. 

      Assure the resident a decision is being made as soon as practicable

    • C. 

      Reprimand the nurse

    • D. 

      Suggest the nurse improve her self-control

  • 112. 
    A physician visit occurring 14 days after the date the visit was required is ___.
    • A. 

      Not considered timely

    • B. 

      Considered timely

    • C. 

      Permitted occasionally

    • D. 

      Routinely permitted

  • 113. 
    If a facility policy prohibits use of physician assistants, but three physicians routinely use physician assistants for most visits, the Medicare inspector will ___.
    • A. 

      Approve the procedure as a Medicare authorized care procedure

    • B. 

      Cite the facility

    • C. 

      Ascertain the acceptability to the residents concerned of use of physician assistants

    • D. 

      Encourage such cost savings to Medicare

  • 114. 
    Ultimate responsibility for obtaining and reporting laboratory, radiology, and other diagnostic services is assigned to the ___.
    • A. 

      Medical director

    • B. 

      Nursing facility

    • C. 

      Attending physician issuing the orders

    • D. 

      Attending physician's office staff

  • 115. 
    The charge nurse notices that lab work recommended for a particular medication has not been ordered and places the order.  The administrator should ___.
    • A. 

      Sign off on the order

    • B. 

      Praise the nurse

    • C. 

      Document the order

    • D. 

      Be upset

  • 116. 
    A facility need not first consult with the resident or the resident's physician when there is ___.
    • A. 

      An accident involving injury

    • B. 

      A decision to transfer

    • C. 

      A change in roommate

    • D. 

      A medical emergency

  • 117. 
    The medical director declined to take responsibility for monitoring and ensuring implementation of resident care policies feeling this was too time consuming.  The administrator would be well advised to ___.
    • A. 

      Agree with the medical director

    • B. 

      Enter a complaint to the state about the medical director

    • C. 

      Find a new medical director

    • D. 

      Assign that task to the director of nursing

  • 118. 
    Upon learning that, to save expenses, the director of nurses has determined that drug records are in order and that all controlled drugs are accounted for, the administrator should ___.
    • A. 

      Be pleased and compliment the DON

    • B. 

      Thank the DON for the information and continue about his/her business

    • C. 

      Call the consulting pharmacist

    • D. 

      Plan an inservice for other nurses

  • 119. 
    Permitting a resident, whose physician permits drugs judged unnecessary but demanded by the resident, to continue to take unnecessary drugs ___.
    • A. 

      Is encouraged

    • B. 

      Is generally acceptable

    • C. 

      Is not permitted

    • D. 

      Is permitted if the resident self-administers drugs

  • 120. 
    New facilities certified under Final Rules must meet the applicable provisions of the ___.
    • A. 

      National Fire Protection Association

    • B. 

      Occupational Safety and Health Act as amended

    • C. 

      Life Safety Code of 2000

    • D. 

      Life Safety Code of 1990

  • 121. 
    Plan D, implemented in 2008, was intended to ___.
    • A. 

      Provide stricter oversight of care

    • B. 

      Provide relief from medication expenses

    • C. 

      Cover outlier costs

    • D. 

      Decrease federal involvement

  • 122. 
    An individual who can prove he or she recently successfully completed a training and competency evaluation program, but who is not actually registered in the required registry ___ as a nurses aide.
    • A. 

      Can be hired

    • B. 

      Must not be hired

    • C. 

      Is temporarily eligible for hiring

    • D. 

      Is like overqualified

  • 123. 
    Responsibility for determining whether the nurses aide training and competency evaluation requirements are met in a facility falls to the ___.
    • A. 

      Medicare inspectors

    • B. 

      Medicaid inspectors

    • C. 

      State Nursing Board

    • D. 

      State survey agency

  • 124. 
    The owner of a facility providing nearly the best nurses aide training and competency evaluation program in the state declines to permit an unannounced visit by the State.  The State will ___.
    • A. 

      Return at a more acceptable time

    • B. 

      Withdraw approval of the training program

    • C. 

      Make an announced visit within 5 working days

    • D. 

      Make an announced visit within 10 working days

  • 125. 
    The required curriculum for a nurses aide training program does not have to include ___.
    • A. 

      Basic nursing skills

    • B. 

      Personal care skills

    • C. 

      Care of cognitively impaired residents

    • D. 

      Diet management

  • 126. 
    Candidates for nurses aide competency evaluation are normally examined by ___.
    • A. 

      A Medicare participating skilled nursing facility

    • B. 

      A Medicaid nursing facility

    • C. 

      The individual's own facility

    • D. 

      A State-approved entity

  • 127. 
    Under federal guidelines, a candidate for nurses aide registration has ___ chances to take the evaluation.
    • A. 

      Two

    • B. 

      No more than three

    • C. 

      Four

    • D. 

      At least three

  • 128. 
    A finding by the State survey agency of abuse or neglect by a nurses aide remains recorded in the nurse aide registry ___.
    • A. 

      For 2 years

    • B. 

      For 4 years

    • C. 

      Forever

    • D. 

      During the recommended probation period

  • 129. 
    Ensuring that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs is the responsibility of ___.
    • A. 

      The State

    • B. 

      Medicaid program officials

    • C. 

      Medicare officials

    • D. 

      The facility

  • 130. 
    Under Final Rules, routine and emergency dental services are ___.
    • A. 

      Optional

    • B. 

      Mandated

    • C. 

      Upon request of the resident

    • D. 

      Upon order of the resident's physician

  • 131. 
    The director of nursing mentions to the administrator that although Ms. Brown had no significant change in her physical or mental condition upon readmission, a full comprehensive assessment was completed within 5 days of her return.  The administrator might feel ___.
    • A. 

      Facility resources might not be utilized efficiently

    • B. 

      Satisfied that effectiveness had been achieved

    • C. 

      Pleased that the assessment was within the 14 day window

    • D. 

      Alarmed

  • 132. 
    To stretch resources, the care planning team decides to conduct comprehensive assessments on the healthiest patients every 15 months.  The administrator should feel ___.
    • A. 

      That the staff is making a reasonable choice

    • B. 

      The staff is being proactive

    • C. 

      A deficiency is in his future

    • D. 

      The care team has saved the facility some expenditures

  • 133. 
    Standards of quality for care given in the nursing facility ___.
    • A. 

      May be found in several venues

    • B. 

      Come only from CMS

    • C. 

      Are those set out in the Federal Requirements

    • D. 

      Can be developed by the facility or its parent body

  • 134. 
    The nurse on duty has informed Ms. Brown that Ms. Brown must make arrangement sfor transportation to her audiologist.  This is ___.
    • A. 

      Correct

    • B. 

      Not permitted facility policy

    • C. 

      Prudent shepherding of facility staff time

    • D. 

      A realistic response

  • 135. 
    Psychosocial adjustment difficulties ___.
    • A. 

      Are inevitable

    • B. 

      Are not common in today's environment

    • C. 

      Are the responsibility of the resident

    • D. 

      Must be treated by the facility

  • 136. 
    For several months in succession, it is noted in the resident's records that the resident is becoming more withdrawn.  The facility ___.
    • A. 

      Has met its record keeping requirements

    • B. 

      Should show more staff interest in this resident

    • C. 

      Must develop a plan of care to address this

    • D. 

      Should provide more opportunities for interaction among the residents

  • 137. 
    For nasogastrically fed patients, the facility program is to provide treatment and services to prevent aspiration, pneumonia, diarrhea, vomiting, dehydration, and metabolic abnormalities.  This ___.
    • A. 

      Is satisfactory

    • B. 

      Is more than required

    • C. 

      Meets minimum standards

    • D. 

      Is insufficient

  • 138. 
    Ms. Green has been shouting incoherently at nearby residents.  Her physician prescribes an antipsychotic drug to calm her down.  This ___.
    • A. 

      Is reasonable

    • B. 

      Is necessary for the comfort of the other residents

    • C. 

      Is unacceptable

    • D. 

      Follows usual medical practice decisions

  • 139. 
    The facility must provide a separately locked, permanently affixed compartment for storage of controlled drugs listed in Schedule ___ of the Drug Act.
    • A. 

      I

    • B. 

      II

    • C. 

      III

    • D. 

      V

  • 140. 
    Controlled drugs listed in Schedule I of the Comprehensive Drug Abuse Act of 1970 are ___.
    • A. 

      To be kept locked

    • B. 

      To be kept locked and under proper temperature controls

    • C. 

      Not permitted in the facility

    • D. 

      Used only on the order of a licensed physician

  • 141. 
    The administrator's policy is to discard all clinical records after ten years.  This policy is ___.
    • A. 

      In accordance with requirements

    • B. 

      Practical: meets all possible state and federal requirements

    • C. 

      Flawed

    • D. 

      Causing unduly long retention of records

  • 142. 
    The Resident Assessment Instrument is a set of screening, clinical, and functional status elements that form the basis for ____.
    • A. 

      A comprehensive assessment of each resident

    • B. 

      A thorough plan of care

    • C. 

      Improving reimbursement

    • D. 

      Capacity for a look-back in care needs

  • 143. 
    Specific resident responses for one or a combination of MDS elements are ___.
    • A. 

      The minimum elements

    • B. 

      The RAI

    • C. 

      The Care Area Triggers

    • D. 

      The care plan

  • 144. 
    The MDS care planning process can be visualized as:  assessment, decision making, and ____.
    • A. 

      Follow-up

    • B. 

      Visualization of resident needs

    • C. 

      Documentation of resident preferences

    • D. 

      Care plan

  • 145. 
    In planning an annual survey, the surveyor begins with reviewing current government data records on the facility, current complaints, Ombudsman information, and ____.
    • A. 

      The facility care plans

    • B. 

      The comprehensive assessments

    • C. 

      Current MDS data

    • D. 

      All OSCAR data

  • 146. 
    The surveyors expect information on contact persons for complaints or abuse, a list of ventilator dependent residents, a list of residents on hospice, a list of dialysis patients within ____ hours of entering a facility for survey.
    • A. 

      One day

    • B. 

      One hour

    • C. 

      Four hours

    • D. 

      24 hours

  • 147. 
    The administrator can expect surveyors to generate ____ lists of residents to be interviewed.
    • A. 

      Two

    • B. 

      Eight

    • C. 

      Three or more

    • D. 

      Six

  • 148. 
    As a matter of policy, at the Exit Conference ____ are/is invited to attend.
    • A. 

      All resident council members

    • B. 

      The resident council president

    • C. 

      Any interested residents

    • D. 

      Only invited residents

  • 149. 
    If a facility plan of correction is found unacceptable ____.
    • A. 

      The facility is fined

    • B. 

      A fast-track process will begin

    • C. 

      The facility can appeal

    • D. 

      A new plan of correction must be submitted

  • 150. 
    Normally, a plan of correction ____.
    • A. 

      Is accepted by the state

    • B. 

      Meets requirements

    • C. 

      Triggers a revisit

    • D. 

      Is appealed

  • 151. 
    Hoping to delay an enforcement action, the administrator asks for an Informal Dispute Resolution.  The administrator ____.
    • A. 

      Does not understand the process

    • B. 

      Has made a prudent move

    • C. 

      Is taking advisable defensive action

    • D. 

      Will likely win at least half the time

  • 152. 
    A finding by surveyors that in both wings of the facility the water to resident rooms and baths is 8 degrees above the upper limit, but that no one had yet been burned, would result in a deficiency characterized as ____.
    • A. 

      Broad and high

    • B. 

      Widespread

    • C. 

      Widespread, no actual harm with minimum potential for actual harm

    • D. 

      Widespread, no actual harm with potential for more than minimal harm

  • 153. 
    The CMS goal is to reimburse based on how much ____ is required to care for each patient each month.
    • A. 

      Money

    • B. 

      Staff in place

    • C. 

      Effort

    • D. 

      Staff time

  • 154. 
    There are ____ levels and types of care for reimbursing nursing facility care given.
    • A. 

      Increasing diverse

    • B. 

      Sixty-six

    • C. 

      Fifteen

    • D. 

      Five broad categories of

  • 155. 
    The MDS contains items that reflect the ____ of the resident.
    • A. 

      Activity level

    • B. 

      Ability to pay

    • C. 

      General circumstances

    • D. 

      Acuity level

  • 156. 
    The Medicare-required assessments provide information about the clinical condition of beneficiaries.  These assessments ____.
    • A. 

      Can be scheduled in advance

    • B. 

      Can be unscheduled

    • C. 

      Can be scheduled or unscheduled

    • D. 

      Can be known in advance

  • 157. 
    Readmission/return assessment, start of therapy, and end of therapy are ____.
    • A. 

      Excluded from standardized assessment dates

    • B. 

      Standardized assessment dates

    • C. 

      The 5-, 14-, 30-, 60-, 90- day assessments

    • D. 

      More highly reimbursed

  • 158. 
    The RUG-IV classification system has ____ major categories.
    • A. 

      Four

    • B. 

      Eight

    • C. 

      Twelve

    • D. 

      A varying number of

  • 159. 
    The scheduled PPS assessment (performed around Day 5, 14, 30, 60, and 90) establish ____ for associated standard payment periods.
    • A. 

      A little used basis

    • B. 

      A free moving basis

    • C. 

      Per diem payment rates

    • D. 

      Monthly rates

  • 160. 
    The ADL score is based upon the ADL's:  ____.
    • A. 

      Bed mobility, activities, toilet use, and ambulating

    • B. 

      Transferring, eating, and activities

    • C. 

      Walking, bed mobility, and eating

    • D. 

      Bed mobility, transfer, toilet use, and eating

  • 161. 
    A cancer patient receiving intensive therapies may ____.
    • A. 

      Be a good source of extra revenue

    • B. 

      Be an ideal admission

    • C. 

      Cost the facility more than it will be reimbursed

    • D. 

      Increase facility cash flow positively

  • 162. 
    The current long-term health care delivery system is one in which each player seeks to minimize its own costs at the possible expense of ____.
    • A. 

      The taxpayers

    • B. 

      Private paying patients

    • C. 

      The revenue base

    • D. 

      Other players in the system

  • 163. 
    How much a facility can charge for care given can be characterized as ____.
    • A. 

      A given

    • B. 

      Easy to chart

    • C. 

      A simple computer algorithm

    • D. 

      A moving target

  • 164. 
    Establishing transfer and discharge policies according to source of payment ___ under Final Rules.
    • A. 

      Is permitted

    • B. 

      Is discouraged

    • C. 

      Is forbidden

    • D. 

      Must be fully documented