LTC-CIP Antimicrobial and Diagnostic Stewardship Questions
Published 2026-10-26 · Facts and text checked 2026-10-16 · Questions from our LTC-CIP study guide · Reviewed by Hana N., Quality Reviewer
These free LTC-CIP practice questions cover Antimicrobial and Diagnostic Stewardship, part of Antimicrobial Stewardship (9 items) on the exam. Core elements of stewardship and appropriate testing in long-term care. Each question comes from a practice test in our LTC-CIP study guide and shows the correct answer with an explanation. The full exam has 150 questions (135 scored).
Core elements of stewardship and appropriate testing in long-term care. On the exam this is part of Antimicrobial Stewardship (9 items). Open each answer to read the explanation.
Question 1Medium
A resident with a cough has clear lungs on auscultation, normal oxygen saturation, and no fever. The nurse contacts the prescriber. Which ordering pattern reflects a common stewardship mistake?
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Correct answer: C. Prescribing a broad-spectrum antibiotic for a possible respiratory infection
Prescribing a broad-spectrum antibiotic for a resident with a cough and clear lungs is a common stewardship mistake because many respiratory syndromes in long-term care are viral and do not benefit from antibiotics. Appropriate management includes monitoring, symptomatic care, and a chest x-ray only if indicated.
From practice test 9 of our LTC-CIP study guide (question 132). Original question, not an official exam item.
Question 2Medium
A 78-year-old resident with dementia and chronic incontinence develops a low-grade fever (37.9°C) and cloudy urine. The on-call provider is contacted by phone, does not examine the resident, and orders a urinalysis and culture. The urinalysis shows leukocyte esterase and bacteria. The provider prescribes ciprofloxacin without further assessment. Which statement best describes the primary risk of this approach?
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Correct answer: B. It risks treating asymptomatic bacteriuria, which exposes the resident to antibiotic side effects such as C. difficile infection without clinical benefit.
The low-grade fever and cloudy urine alone do not meet clinical criteria for a symptomatic urinary tract infection, so this approach treats asymptomatic bacteriuria. That exposes the resident to unnecessary antibiotic harm, including C. difficile infection and increased resistance, without any clinical benefit.
From practice test 3 of our LTC-CIP study guide (question 49). Original question, not an official exam item.
Question 3Easy
The infection preventionist is presenting the antibiotic stewardship program to the facility administrator. Which outcome should be emphasized first to gain administrative support?
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Correct answer: D. The cost of avoidable hospital transfers and the risk of regulatory citations
Administrators are most responsive to financial and regulatory consequences, especially avoidable transfer costs and survey citations. Clinical criteria and specimen collection techniques are more relevant to medical and nursing audiences.
From practice test 4 of our LTC-CIP study guide (question 51). Original question, not an official exam item.
Question 4Medium
A resident with symptomatic urinary tract infection needs an antibiotic. The stewardship pharmacist wants to minimize the risk of Clostridioides difficile infection. Which agent class should be avoided because of its high C. difficile risk?
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Correct answer: D. Fluoroquinolones
Fluoroquinolones are among the antibiotics most strongly associated with C. difficile, together with clindamycin and broad-spectrum cephalosporins. Metronidazole is a treatment for C. difficile, not a high-risk precipitating agent.
From practice test 4 of our LTC-CIP study guide (question 116). Original question, not an official exam item.
Question 5Medium
Which activity best fulfills the 'reporting' element of antimicrobial stewardship?
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Correct answer: C. Providing prescribers with a summary of the facility's antibiotic use data and encouraging discussion at the quality committee
Reporting requires sharing antibiotic use data back to prescribers and the quality committee so the information can inform changes in practice. Submitting data to NHSN alone is not reporting to the facility team.
From practice test 2 of our LTC-CIP study guide (question 143). Original question, not an official exam item.
Question 6Hard
A skilled nursing facility's baseline audit shows many antibiotic starts for suspected urinary tract infection without documented localizing symptoms. The infection preventionist wants one intervention most likely to reduce unnecessary starts. Which approach is the best first step?
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Correct answer: A. Implementing a standing communication tool that requires the prescriber to document a specific indication and a stop date
A standing communication tool at the point of prescribing directly addresses the decisions that drive unnecessary starts. Prior approval is a restrictive barrier, and a poster or delayed check does not alter the initial order.
From practice test 4 of our LTC-CIP study guide (question 95). Original question, not an official exam item.
Question 7Hard
During a one-month audit, a 74-year-old resident develops fever of 39.1°C (102.4°F), hypotension, and no localizing source of infection. The provider starts broad-spectrum antibiotics immediately while blood and urine cultures are pending. The cultures later show no growth, and the fever resolves within 48 hours. How should this prescription be categorized?
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Correct answer: D. Possibly appropriate, because the initial clinical presentation of possible sepsis justified empiric therapy even though cultures were negative.
Appropriateness is judged at the time of the prescribing decision, not from final culture results. Fever and hypotension without a source reasonably justify empiric broad-spectrum therapy, so the prescription is possibly appropriate even though cultures were negative.
From practice test 2 of our LTC-CIP study guide (question 147). Original question, not an official exam item.
Question 8Hard
During a regulatory survey, surveyors ask to see the facility's antimicrobial stewardship activities. Which combination of items are they most likely to request?
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Correct answer: A. The facility's antibiotic use data and its written action plan to improve prescribing
Surveyors increasingly expect facilities to show both their antibiotic use data and a stewardship action plan, as these demonstrate the core elements of tracking and action. Personal preferences, temperature logs, or pharmacist credentials do not fulfill this expectation.
From practice test 3 of our LTC-CIP study guide (question 64). Original question, not an official exam item.
Question 9Hard
A facility uses NHSN reports to set antimicrobial stewardship priorities. These reports show the number of antibiotic starts per 1,000 resident days by indication and drug class. Which limitation should the infection preventionist keep in mind when interpreting these data?
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Correct answer: B. NHSN reports show the volume of antibiotic use but not whether each prescription was clinically appropriate.
NHSN reports provide volume data by indication and drug class, but they do not distinguish appropriate from inappropriate use. Identifying stewardship targets therefore requires combining the report with clinical chart review.
From practice test 2 of our LTC-CIP study guide (question 34). Original question, not an official exam item.
Question 10Medium
A facility wants to compare its antibiotic prescribing volume from one quarter to the next, adjusting for changes in resident census. Which metric is most appropriate for this comparison?
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Correct answer: C. Antibiotic starts per 1,000 resident days
Antibiotic starts per 1,000 resident days is the standard metric that adjusts for resident census, allowing valid comparison across time periods. The other options do not provide a rate with an appropriate denominator.
From practice test 2 of our LTC-CIP study guide (question 48). Original question, not an official exam item.
Question 11Medium
A provider gives a telephone order for an antibiotic for a resident with suspected pneumonia. What must be documented at the time of the antibiotic order?
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Correct answer: C. The suspected infection, supporting signs and symptoms, drug, dose, route, stop date, and reassessment plan
The prescriber must record the suspected infection, the signs and symptoms supporting it, the antibiotic name, dose, route, stop date, and the plan for reassessment. This documentation is the minimum for an actionable antibiotic order.
From practice test 6 of our LTC-CIP study guide (question 30). Original question, not an official exam item.
Question 12Easy
Which action best demonstrates leadership commitment to antimicrobial stewardship at a skilled nursing facility?
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Correct answer: D. Allocating paid staff time for stewardship team meetings and interventions
Leadership commitment means providing resources and support for stewardship work. Paid staff time makes the program operational; the other options are either not stewardship activities or would undermine the program.
From practice test 5 of our LTC-CIP study guide (question 88). Original question, not an official exam item.
Question 13Easy
Why is a staff nurse or charge nurse an essential member of a nursing facility's antimicrobial stewardship team?
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Correct answer: B. This person is present when residents are assessed, urine specimens are collected, and phone calls to prescribers are made, so they directly shape the information that leads to antibiotic orders.
The staff nurse is the person who observes the resident, collects the specimen, and communicates findings to the prescriber, so the nurse directly shapes the information on which the prescribing decision is based. The other roles are not within a staff nurse's scope.
From practice test 2 of our LTC-CIP study guide (question 148). Original question, not an official exam item.
Question 14Easy
In the CDC Core Elements for Antibiotic Stewardship in Nursing Homes, the 'accountability' element specifically requires which of the following?
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Correct answer: A. A single physician or advanced practice provider who accepts responsibility for the facility's antibiotic prescribing outcomes
The accountability element requires a single clinician, either a physician or advanced practice provider, to accept responsibility for the facility's prescribing outcomes. A committee or public report does not meet this specific requirement.
From practice test 2 of our LTC-CIP study guide (question 138). Original question, not an official exam item.
Question 15Hard
According to McGeer surveillance criteria for urinary tract infection in long-term care, which presentation would support a UTI diagnosis?
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Correct answer: A. Fever and new dysuria
The McGeer criteria for UTI can be met by fever plus a localizing urinary sign such as new dysuria, so this presentation supports the diagnosis. The other options lack a localizing urinary sign or are nonspecific findings.
From practice test 8 of our LTC-CIP study guide (question 20). Original question, not an official exam item.
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