Exam cram sheet
National Exam Quick Reference Chart
Every number, timeframe and definition the national exam expects you to recall cold — food temperatures, MDS and care plan deadlines, Medicare day counts, survey clocks, staffing ratios and life safety dimensions.
Showing 252 facts
Environment
Dietary & food service
Temperature and timing questions are almost guaranteed on the exam. Learn the three dishmachine temperatures and the hot/cold holding line first.
- Hot water dishmachine — wash cycle
- 150°F
- Hot water dishmachine — rinse cycle
- 160°F
- Hot water dishmachine — final rinse
- 180°F
- Three-compartment sink — sanitizer (3rd compartment)
- 75°F water with 50 PPM bleach, or 12.5 PPM iodine
- Pots and pans
- Washed in 170°F water for 30 seconds
- Hot food holding / steam table
- 135°F and above
- Cold food and milk
- 41°F and below
- Refrigerators and walk-ins
- 41°F and below
- Freezer
- 0°F
- Poultry cooked to
- 165°F
- Meats cooked to
- 145°F
- Hamburger and hot dogs
- 155°F
- Reheated foods
- 165°F
- Kitchen hours
- Open at least 12 hours a day
- Hours between evening meal and breakfast
- Max 14 hours without a snack; up to 16 hours with a nourishing bedtime snack approved by the resident group
- Bedtime snack
- Required by federal law
- Storage off the floor
- Everything at least 6 inches off the floor
- Menus
- Prepared 4 weeks (1 month) in advance and retained 4 weeks
- Therapeutic diet
- Any diet that deviates from the regular diet
- Who orders a diet
- Only a physician orders it; the dietitian approves it or determines the specifics
- Dietary manager
- Must be full time; if not a registered dietitian, must have monthly consultation with an RD
- MDS 3.0 dietary section
- Section K
- Common thickener consistencies
- Nectar, honey, pudding
Resident care
Assessment & care planning
The MDS and care plan clock questions are pure date math — memorise the day counts.
- Comprehensive assessment (MDS)
- Within 14 days of admission, then every 12 months or on significant change
- Significant change assessment
- New MDS within 14 days
- Physical exam / assessment review
- No less than every 3 months
- Who certifies the MDS
- An RN signs to certify accuracy
- Initial MDS transmission to the state
- Within 7 days of completion
- Ongoing MDS transmission
- Every 30 days
- Comprehensive care plan
- Within 7 days of completing the assessment, and no later than 21 days from admission
- Care plan participants
- Resident, family or legal representative, attending physician and the RN responsible for the resident
- Care plan conference
- Held quarterly
- RAI update
- Now the CAA (Care Area Assessment) = MDS + CAT with 20 care area triggers
- Pain assessment
- Quarterly
- Medication error rate
- Must be 5% or less
Human resources
Nursing & staffing requirements
Ratios, licensure minimums and the 121-bed thresholds show up in scenario questions.
- Nursing services
- 24 hours a day
- RN coverage
- 8 consecutive hours a day, 7 days a week
- Charge nurse
- Required on all 3 shifts
- Nursing hours per resident day
- 3.0 hours
- Residents per licensed nurse
- Maximum 20
- Residents per nurse aide
- Maximum 40
- Full-time social worker
- Required with 121 or more beds (more than 120)
- ADON
- Required with 121 or more beds
- Consecutive nursing hours limit
- Cannot work more than 16 hours for 3 consecutive days
- Nursing waiver
- Facility must have an RN or physician available to respond immediately to calls from the facility
- Nurse aide training
- 75 hours minimum, including 16 hours supervised practical training
- Nurse aide continuing education
- 12 hours per year
- Nurse aide lapse
- Certification lapses after 24 consecutive months without working at least 1 day (8 hours) for pay
- Aide in training
- Cannot work longer than 4 months without passing the certification exam
- Staffing data posting
- Posted daily for each shift, visible to the public
- PBJ
- Payroll Based Journal — payroll and census data transmitted to CMS quarterly
- Employee physicals
- On hire and annually (TB test)
- Medical director
- Responsible for the medical program and approves resident care policies
Regulations
Survey, deficiencies & enforcement
Know the survey window, the 2567 clock and the scope-and-severity grid letters. Actual harm begins at letter G.
- Survey frequency
- Every 9–15 months (statewide average 12 months)
- Report of deficiencies (Form 2567)
- Sent within 10 calendar days of exit
- Plan of correction
- Facility submits within 10 calendar days
- Soonest resurvey
- Not before 30 days from the exit date
- IDR
- Informal dispute resolution — request review of a citation in writing
- FDR
- Formal dispute resolution — request an administrative hearing
- Deadline to request a formal hearing
- 20 calendar days from receipt of the 2567
- Survey results made public
- Within 14 calendar days
- Survey focus since OBRA 1987
- Outcomes (quality of resident life), not process
- Survey types
- Standard, extended, abbreviated standard (complaint), partial extended, resurvey
- Harm in a standard survey
- Triggers an extended survey
- Harm in an abbreviated substandard survey
- Triggers a partial extended survey
- Citation prefixes
- F = federal, N = state, K = life safety
- Level 1 — no harm, no potential
- A isolated, B pattern, C widespread
- Level 2 — no harm, potential for harm
- D isolated, E pattern, F widespread
- Level 3 — actual harm
- G isolated, H pattern, I widespread
- Level 4 — immediate jeopardy
- J isolated, K pattern, L widespread
- Substandard quality of care
- Actual harm — begins at letter G
- CMS 671
- Application for Medicare/Medicaid certification
- CMS 672
- Resident census and conditions
- CMS 802
- Roster / sample matrix
- CMS 805
- Resident review worksheet
- Surveyor access
- Any hour of the day or night, 7 days a week, no notice
- Conflict between state and federal law
- Follow the more stringent standard
- QAA committee
- DON, a designated physician and at least 3 other staff; meets at least quarterly
- QAA records
- Not required to be disclosed to state or federal surveyors
Finance
Medicare, Medicaid & reimbursement
The Medicare SNF benefit day counts are the single most tested set of numbers on the exam.
- Medicare Part A
- Title XVIII — inpatient hospital and SNF care; automatic at 65, no premium
- Qualifying hospital stay
- 3 days (do not count the day of discharge)
- Covered SNF days
- 100 days per benefit period
- Days 1–20
- No co-pay
- Days 21–100
- 20% co-pay
- Return to facility window
- 30 days
- Regenerate a new benefit period
- 60 days out of a facility or hospital
- Medicare Part B
- Outpatient services — must elect it, monthly premium, 20% co-pay from day 1
- Medicare Part D
- Prescription drug plan — enroll, pay premiums and co-pays
- Medicaid
- Title XIX — need-based, covers custodial care
- Medicaid look-back period
- 5 years
- Bed certification changes
- Allowed 2 times per year
- Medicaid cost reports
- Due within 90 days of the end of the fiscal or calendar year
- PASRR
- Level 1 screen for MI/ID before admission; Level 2 if a history is identified
- OBRA 1987 payment change
- Retrospective payment replaced by prospective flat-rate payment
Finance
Accounting & financial management
Know which statement shows what — revenues and expenses never appear on the balance sheet.
- Accounting equation
- Assets = Liabilities + Capital
- Working capital
- Current assets − current liabilities
- Current ratio
- Current assets ÷ current liabilities (1.0:1.0 = break even)
- Quick / acid test ratio
- (Cash + accounts receivable + money market) ÷ current liabilities
- Average length of stay
- Total patient days ÷ number of admissions in the year
- Accounting system used by nursing homes
- Accrual (records when incurred, not when cash moves)
- Cash accounting
- Records transactions when cash changes hands
- Profit and loss statement
- Produced monthly — shows whether revenues covered expenses
- Balance sheet
- Produced every 3 months — shows financial condition, net worth and solvency
- Inventory valuation
- LIFO (last in, first out) and FIFO (first in, first out)
- Periodic inventory
- Initial count, then counted every 12 months
- Perpetual inventory
- Counted constantly throughout the year
- Just in time
- Inventory delivered on the day it is needed
- Economic order quantity
- Enough inventory to meet need — not too much, not too little
- Fixed expenses
- Not affected by census
- Variable expenses
- Change with census
- Semi-variable expenses
- Fixed and variable components, like the electric bill
- Straight line depreciation
- Depreciates evenly each year over the life of the asset
- Accelerated depreciation
- Takes the larger depreciation amount up front
- Chart of accounts
- Listing of revenue and expense codes used to code invoices
- To increase cash
- Collect accounts receivable; paying down payables decreases cash
- Resident fund accounting
- Statement provided quarterly (every 3 months)
- Refund of resident funds
- Within 30 days of discharge or death
Human resources
Human resources & management
Interview types, rating errors and management styles are definition questions — learn the wording.
- Preliminary interview
- Brief screen (often by telephone) to decide whether to interview
- Non-structured interview
- Open-ended questions; applicant expands on answers
- In-depth interview
- Very structured; limits applicant responses
- Patterned interview
- Highly structured, sequential questions
- Structured (statistical) interview
- Open-ended questions scored on a rating scale
- Medical exams and drug testing
- Only after an offer of hire
- Halo effect
- Judging someone on a single trait
- Error of central tendency
- Rating everyone as average
- Leniency error
- Rating substandard performance as acceptable to avoid confrontation
- Merit increase
- Based on performance
- COLA
- Cost of living increase based on inflation (CPI)
- Equity increase
- Keeps longer-serving staff at current market rates
- Benchmarking
- Comparing salaries within one wage group
- Best way to advertise open jobs
- Staff referral
- Adverse impact
- Minority hiring rate must be at least 80% of the majority rate
- Retain employment applications
- 6 months
- Job description
- Title, requirements, salary, reporting line and tasks
- Job analysis
- Collecting information about the duties, skills and environment of a job
- Job specification
- Knowledge, skills, education and abilities needed to perform the job
- Progressive discipline
- Verbal warning, 3 write-ups, termination
- Line authority
- Solid line — can give direction to staff
- Advisory authority
- Dotted line — consultant may recommend but not direct
- Autocratic style
- Dictatorial, micromanaging
- Paternal style
- Supportive, wants employees to succeed — considered the best style
- Laissez-faire style
- Delegates and steps in only when something goes wrong
- Democratic style
- Manages by consensus
- Value vs norm
- A value is vague like a policy; a norm is specific like a procedure
- Policies vs procedures
- Policies written by upper/middle management; procedures by middle/lower
- LBWA
- Leadership by Walking Around (formerly MBWA)
Regulations
Key federal laws
Match the law to the enforcing agency — that pairing is what the exam usually asks for.
- Civil Rights Act 1964
- Protects race, religion, color, gender, national origin — enforced by EEOC
- Equal Employment Opportunity Act 1972
- Defined discrimination as adverse impact — EEOC
- Equal Pay Act
- Equal pay for the same work — EEOC
- Age Discrimination in Employment Act
- Protects workers 40+; applies with 20 employees — EEOC
- Pregnancy Discrimination Act
- Protects pregnant workers in hiring and benefits — EEOC
- Rehabilitation Act 1973
- Bars handicap discrimination by recipients of federal funds — EEOC
- Fair Labor Standards Act
- Minimum wage, overtime, youth permits — Department of Labor
- FMLA
- 12 weeks unpaid leave; must work 12 months and 1,250 hours
- COBRA
- Continued insurance coverage up to 18 months at the worker's full premium
- HIPAA
- Portability — new insurer may limit pre-existing conditions no more than 12 months
- FICA
- Funds Social Security; employer pays 50%
- FUTA
- Federal unemployment tax; benefits paid up to 26 weeks
- OSHA
- Applies with 11 employees; agency under the Department of Labor
- OSHA 300 log
- Record non-fatal injuries within 7 days
- OSHA fatality reporting
- Fatalities or 3+ hospitalizations reported by phone within 8 hours
- OSHA Form 300A
- Year-end summary posted February 1 – April 30
- OSHA Form 301
- Supplemental full investigation report
- OSHA violation posting
- Posted for 3 days
- OSHA medical records
- Kept for employment plus 30 years
- OSHA compliance categories
- Imminent danger, serious, non-serious, de minimis
- Most cited OSHA deficiency
- Failure to post the SDS (formerly MSDS)
- NIOSH
- Provides research to OSHA
- Safe Medical Devices Act
- Report device-related injury within 10 days to the manufacturer and FDA
- Patient Self-Determination Act
- Inform residents of the right to an advance directive; cannot require one
- Older Americans Act
- Funds senior services for those 60+; created the LTC ombudsman
- False Claims Act
- Fraudulent claims submitted to Medicare
- Stark / self-referral
- Prohibits referring to a facility the provider owns
- Immigration Reform Act
- Verify citizenship status prior to hire
- USERRA
- Guard and reserve members return to their jobs after service
- CLIA waiver
- Required for glucose meter testing; renewed annually
- ERISA
- Protects pension funds; does not require an employer to offer a plan
Environment
ADA, life safety & physical plant
Dimensions and fire ratings — these are straight recall questions worth easy points.
- Resident and interior doors
- Minimum 44 inches wide
- Bathroom door
- 32 inches wide
- Resident door construction
- 1¾ inches thick, solid wood core, 20-minute fire rating
- Double fire doors
- 1½ hour fire rating
- Smoke compartment walls
- 2 hour fire rating
- Max length of a smoke compartment
- 150 feet
- Max travel distance within a smoke compartment
- 200 feet
- Max area of a smoke compartment
- 22,500 square feet
- Smoke compartments per floor
- At least 2 on each level
- Room to corridor door distance
- No more than 50 feet
- Handicap parking space
- 13 feet wide
- Clear width for a wheelchair
- 36 inches
- High forward reach from a wheelchair
- 48 inches
- Side reach from a wheelchair
- 9 to 54 inches
- Knee space
- 19 inches; toe space 9 inches
- Door or faucet opening force
- No more than 5 pounds of pressure
- Railing load
- Must bear 250 pounds
- Ambient temperature
- 71–81°F, measured from the floor up to 3 feet
- Exit sign illumination
- 1 candle foot at the floor
- Life Safety Code edition
- 2012 edition
Resident care
Clinical & resident rights
Pressure injury staging and record access timeframes appear in nearly every practice set.
- Stage 1 pressure injury
- Red or inflamed but unbroken skin
- Stage 2
- Blister or open sore from the dermis into subcutaneous fat
- Stage 3
- Extends through subcutaneous fat down into fascia
- Stage 4
- Deep ulceration down to the bone
- Stasis ulcer
- Circulation-related ulcer on the extremities — not caused by pressure
- Physical therapy
- Lower body and weight-bearing muscles used to walk
- Occupational therapy
- Upper body and activities of daily living
- Speech therapy
- Speech abnormalities and swallowing difficulty
- Respiratory therapy
- Breathing problems
- Custodial / intermediate care
- ADL assistance, monitoring intake and medication administration
- Skilled nursing care
- Tube feeding, wound care, IVs — requires a licensed nurse
- Palliative care
- Care to relieve pain
- Respite care
- Short stay that gives the caregiver a break
- Resident records retention
- 5 years from discharge (minors: 3 years past the age of majority)
- Resident inspects their record
- Within 24 hours of request (excluding weekends and holidays)
- Copies of the record
- Within 48 hours (2 working days); reasonable copy charge allowed
- Access by surveyors, ombudsman, law enforcement
- Immediate, no resident consent required
- Access by family
- Immediate, subject to the resident's right to refuse
- Eden Alternative
- Plants, pets and purpose to make the facility more homelike
- Holistic care
- Addresses spiritual, emotional and physical needs
- PPE
- Face mask, gloves, gowns
Leadership
Governance, legal & insurance
The governing body versus administrator split is a frequent trick question.
- Governing body
- Ultimate legal responsibility; approves the budget, policies and mission statement
- Administrator
- Responsible for day-to-day management of the facility
- Mission statement
- The purpose of the company
- Philosophy
- The foundation of the company
- By-laws
- Govern the corporation and shareholder rights
- Certificate of incorporation
- Forms the corporation when filed with the state
- General liability insurance
- Injuries to visitors and contractors on the property
- Professional liability / malpractice
- Injury to a patient caused by clinical staff
- Officers and directors insurance
- Legal fees when officers are sued for acts within their role
- Business interruption insurance
- Lost income when a disaster stops operations
- Vicarious liability / respondeat superior
- Employer is responsible for the acts of its employees
- Negligence
- Improper care or failure to meet standards that harms a patient
- Malpractice
- Failure to provide care in accordance with professional standards
- Tort
- A civil wrong causing injury where a duty to prevent it existed
- Mediation
- Third party facilitates a mutually agreeable resolution
- Arbitration
- Third party renders a final, usually binding decision
- Subpoena duces tecum
- Order to appear with records
- Statute vs rule
- A statute is passed by a legislature; a rule (regulation) is made by an agency
- Federal Register
- Where new federal regulations are first published
- Durable power of attorney
- Covers both financial and health care matters
- Power of attorney
- Financial matters only
- Living will
- Addresses artificial life-prolonging measures
- AHCA
- Represents for-profit nursing homes
- OIG
- Investigates Medicare and Medicaid fraud
Human resources
Labor relations
Four union laws and four percentages — a compact, high-yield block.
- NLRB
- Sole jurisdiction over labor matters; approves bargaining units and elections
- Bargaining units in a nursing home
- 2 — professional and non-professional
- To hold a union election
- 30% of workers sign an interest card
- To approve a union
- 50% + 1 of workers voting
- Norris-LaGuardia Act
- Bars federal courts from enjoining a strike
- Wagner Act
- Requires collective bargaining; created the NLRB
- Taft-Hartley Act
- 10 days strike notice, 90 days contract change notice, 80-day presidential halt
- Landrum-Griffin Act
- Union financial disclosure; protects members from their union
- SEIU
- Represents most nursing home employees
- Management restrictions
- Cannot attend union meetings, fund a union, or question attendance
This chart condenses widely taught federal standards for exam study. Verify current figures against 42 CFR Part 483, the State Operations Manual Appendix PP and your state requirements before applying them in practice.
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