NAB RCAL EXAM NEWEST 2025/2026 ACTUAL EXAM COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
Question 1
Which of the following statements regarding anxiety in the elderly population within an assisted
living environment is most accurate?
A) Anxiety is a rare psychological phenomenon in long-term care.
B) Anxiety is a common and expected reaction to various forms of stress.
C) Anxiety is always a sign of early-onset dementia.
D) Anxiety should only be treated with pharmacological interventions.
E) Anxiety is a physiological reaction that does not require assessment.
Correct Answer: B) Anxiety is a common and expected reaction to various forms of stress.
Rationale: In the residential care setting, anxiety is recognized as a common reaction to
stressors such as relocation, loss of independence, declining health, or the death of peers.
Understanding that anxiety is a frequent response allows administrators to ensure staff are
trained in non-pharmacological interventions and psychological support. While it can co-
occur with dementia, it is not an absolute indicator of it.
Question 2
According to quality standards in assisted living, which of the following scenarios would
necessitate a mandatory resident assessment update?
A) The resident attends a new activity in the community.
B) The resident's family visits for a holiday.
C) The resident returns to the facility following a hospital stay.
D) The resident changes their preferred brand of soap.
E) The resident decides to wake up one hour earlier than usual.
Correct Answer: C) The resident returns to the facility following a hospital stay.
Rationale: A resident assessment update (or significant change in status assessment) is
triggered by events that alter the resident's baseline functional or clinical status. Standard
triggers include a return from a hospital stay, significant weight loss, a change in cognitive
impairment, new or frequent falls, changes in ambulation, skin breakdown, or the
emergence of erratic behaviors. These events require a re-evaluation of the care plan to
ensure resident safety and appropriate service delivery.
Question 3
Which of the following best defines a Pressure Injury (PI) or Pressure Ulcer (PU) in a residential
care setting?
A) A viral infection of the dermal layer.
B) Localized damage to the skin and/or underlying soft tissue, usually over a bony prominence.
C) A bruise caused by a sudden impact or fall.
D) A rash resulting from an allergic reaction to medication.
E) Skin irritation caused exclusively by poor hygiene.
, 2
Correct Answer: B) Localized damage to the skin and/or underlying soft tissue, usually over
a bony prominence.
Rationale: Pressure injuries are localized areas of tissue damage resulting from intense
and/or prolonged pressure, or pressure in combination with shear. They typically occur
over bony prominences (like the sacrum or heels) but can also be related to medical devices.
They present as open ulcers or intact skin with localized discoloration and can be
significantly painful, requiring staged clinical management.
Question 4
Which of the following strategies is considered a primary component of pressure injury
prevention for residents at risk?
A) Applying heavy layers of cornstarch to all skin surfaces.
B) Utilizing position change alarms for every resident in the facility.
C) Identifying risk factors upon admission and evaluating condition changes.
D) Keeping the resident in a supine position for at least 12 hours a day.
E) Massaging reddened areas over bony prominences vigorously.
Correct Answer: C) Identifying risk factors upon admission and evaluating condition
changes.
Rationale: Prevention begins with a comprehensive assessment upon admission to identify
specific risk factors (e.g., immobility, incontinence, malnutrition). Effective prevention
involves implementing, monitoring, and modifying interventions based on changes in the
resident's condition. While alarms can be used, they should be used sparingly and are not a
substitute for manual repositioning. Massaging reddened areas is contraindicated as it can
cause further deep tissue damage.
Question 5
In the context of facility incident management, how is an "unavoidable accident" defined?
A) An accident that happens when no staff members are on the floor.
B) An accident that occurred despite sufficient and comprehensive facility systems.
C) An accident involving a resident who refused to follow the care plan.
D) An accident that was not witnessed by any staff or family members.
E) Any fall that results in a fracture.
Correct Answer: B) An accident that occurred despite sufficient and comprehensive facility
systems.
Rationale: The term "unavoidable" is used by regulatory bodies to describe an incident that
took place even though the facility had performed a proper assessment, implemented
appropriate safeguards, monitored the resident, and revised the care plan as needed. If the
facility did everything within the standard of care to prevent the event, it is deemed
unavoidable. This highlights the importance of documentation and systemic risk
management.
, 3
Question 6
A resident is admitted to an RCAL facility and is continent of bladder and bowel. What is the
facility's responsibility regarding this resident's elimination status?
A) Place the resident on a preventative catheterization schedule.
B) Provide services and assistance to maintain continence unless a clinical condition makes it
impossible.
C) Limit fluid intake after 6:00 PM for all residents to prevent nighttime accidents.
D) Require the resident to wear adult briefs as a standard precaution.
E) Only assist with toileting if the resident explicitly asks for help.
Correct Answer: B) Provide services and assistance to maintain continence unless a clinical
condition makes it impossible.
Rationale: The goal of person-centered care is to maintain the highest level of function
possible. For a resident who is continent upon admission, the facility must provide the
necessary support (toileting schedules, environmental modifications) to prevent decline into
incontinence. Continence should only be considered "not possible" if a specific clinical
diagnosis or physical/cognitive decline makes it so.
Question 7
Under what circumstances should a resident who entered the facility without an indwelling
catheter be catheterized?
A) When it is more convenient for the staff during busy shifts.
B) Only if the resident's clinical condition demonstrates that catheterization is necessary.
C) If the resident has one episode of urinary incontinence.
D) To collect a routine urine sample for a physical.
E) If the resident requests it to avoid using a bedpan.
Correct Answer: B) Only if the resident's clinical condition demonstrates that
catheterization is necessary.
Rationale: Indwelling catheters are associated with high risks of Urinary Tract Infections
(UTIs) and physical discomfort. Clinical standards dictate that they should not be used as a
treatment for incontinence or for staff convenience. They are reserved for specific medical
needs, such as acute urinary retention or end-of-life comfort when other methods are
ineffective.
Question 8
If a resident is admitted to the facility with an existing indwelling catheter, what is the required
nursing action?
A) Keep the catheter in place indefinitely to prevent leaks.
B) Assess the resident for the removal of the catheter as soon as possible.
C) Change the catheter every 24 hours to ensure sterility.
D) Immediately remove the catheter without a physician’s order.
, 4
E) Encourage the resident to avoid drinking fluids to keep the bag empty.
Correct Answer: B) Assess the resident for the removal of the catheter as soon as possible.
Rationale: Residents admitted with catheters must be evaluated to determine if the medical
necessity for the device still exists. The goal is to remove the catheter as soon as clinically
viable to reduce the risk of infection and promote the resident's independence and physical
well-being. This requires collaboration with the attending physician.
Question 9
For a resident experiencing fecal incontinence, the facility must ensure that the resident receives
appropriate treatment and services to:
A) Ensure they remain in their room at all times.
B) Restore as much normal bowel function as possible.
C) Restrict the resident's fiber intake to slow digestion.
D) Encourage the use of diapers as the only intervention.
E) Only provide care after an accident has occurred.
Correct Answer: B) Restore as much normal bowel function as possible.
Rationale: Fecal incontinence requires a comprehensive assessment of the cause (e.g., diet,
medication, physical mobility). The facility's responsibility is to provide restorative
services, such as bowel training or dietary adjustments, aimed at returning the resident to a
normal or manageable elimination pattern, thereby preserving dignity and skin integrity.
Question 10
In which of the following resident populations is "prompted-voiding" most commonly utilized as
an effective intervention?
A) Residents who are fully independent and continent.
B) Dependent or more cognitively impaired residents who need assistance with toileting.
C) Residents who have a permanent supra-pubic catheter.
D) Residents who are in a comatose state.
E) Residents who are only in the facility for short-term physical therapy.
Correct Answer: B) Dependent or more cognitively impaired residents who need assistance
with toileting.
Rationale: Prompted voiding is a behavioral technique where staff regularly ask residents if
they need to use the bathroom and provide praise or positive reinforcement for successful
voiding. It is specifically designed for residents with cognitive impairments (like dementia)
or physical dependencies who may not recognize or act on the urge to void until it is too
late.
Question 11
The appropriate treatment and services provided to a resident to maintain or improve their ability
to carry out Activities of Daily Living (ADLs) must include which of the following?
A) Only hygiene and mobility.
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
Question 1
Which of the following statements regarding anxiety in the elderly population within an assisted
living environment is most accurate?
A) Anxiety is a rare psychological phenomenon in long-term care.
B) Anxiety is a common and expected reaction to various forms of stress.
C) Anxiety is always a sign of early-onset dementia.
D) Anxiety should only be treated with pharmacological interventions.
E) Anxiety is a physiological reaction that does not require assessment.
Correct Answer: B) Anxiety is a common and expected reaction to various forms of stress.
Rationale: In the residential care setting, anxiety is recognized as a common reaction to
stressors such as relocation, loss of independence, declining health, or the death of peers.
Understanding that anxiety is a frequent response allows administrators to ensure staff are
trained in non-pharmacological interventions and psychological support. While it can co-
occur with dementia, it is not an absolute indicator of it.
Question 2
According to quality standards in assisted living, which of the following scenarios would
necessitate a mandatory resident assessment update?
A) The resident attends a new activity in the community.
B) The resident's family visits for a holiday.
C) The resident returns to the facility following a hospital stay.
D) The resident changes their preferred brand of soap.
E) The resident decides to wake up one hour earlier than usual.
Correct Answer: C) The resident returns to the facility following a hospital stay.
Rationale: A resident assessment update (or significant change in status assessment) is
triggered by events that alter the resident's baseline functional or clinical status. Standard
triggers include a return from a hospital stay, significant weight loss, a change in cognitive
impairment, new or frequent falls, changes in ambulation, skin breakdown, or the
emergence of erratic behaviors. These events require a re-evaluation of the care plan to
ensure resident safety and appropriate service delivery.
Question 3
Which of the following best defines a Pressure Injury (PI) or Pressure Ulcer (PU) in a residential
care setting?
A) A viral infection of the dermal layer.
B) Localized damage to the skin and/or underlying soft tissue, usually over a bony prominence.
C) A bruise caused by a sudden impact or fall.
D) A rash resulting from an allergic reaction to medication.
E) Skin irritation caused exclusively by poor hygiene.
, 2
Correct Answer: B) Localized damage to the skin and/or underlying soft tissue, usually over
a bony prominence.
Rationale: Pressure injuries are localized areas of tissue damage resulting from intense
and/or prolonged pressure, or pressure in combination with shear. They typically occur
over bony prominences (like the sacrum or heels) but can also be related to medical devices.
They present as open ulcers or intact skin with localized discoloration and can be
significantly painful, requiring staged clinical management.
Question 4
Which of the following strategies is considered a primary component of pressure injury
prevention for residents at risk?
A) Applying heavy layers of cornstarch to all skin surfaces.
B) Utilizing position change alarms for every resident in the facility.
C) Identifying risk factors upon admission and evaluating condition changes.
D) Keeping the resident in a supine position for at least 12 hours a day.
E) Massaging reddened areas over bony prominences vigorously.
Correct Answer: C) Identifying risk factors upon admission and evaluating condition
changes.
Rationale: Prevention begins with a comprehensive assessment upon admission to identify
specific risk factors (e.g., immobility, incontinence, malnutrition). Effective prevention
involves implementing, monitoring, and modifying interventions based on changes in the
resident's condition. While alarms can be used, they should be used sparingly and are not a
substitute for manual repositioning. Massaging reddened areas is contraindicated as it can
cause further deep tissue damage.
Question 5
In the context of facility incident management, how is an "unavoidable accident" defined?
A) An accident that happens when no staff members are on the floor.
B) An accident that occurred despite sufficient and comprehensive facility systems.
C) An accident involving a resident who refused to follow the care plan.
D) An accident that was not witnessed by any staff or family members.
E) Any fall that results in a fracture.
Correct Answer: B) An accident that occurred despite sufficient and comprehensive facility
systems.
Rationale: The term "unavoidable" is used by regulatory bodies to describe an incident that
took place even though the facility had performed a proper assessment, implemented
appropriate safeguards, monitored the resident, and revised the care plan as needed. If the
facility did everything within the standard of care to prevent the event, it is deemed
unavoidable. This highlights the importance of documentation and systemic risk
management.
, 3
Question 6
A resident is admitted to an RCAL facility and is continent of bladder and bowel. What is the
facility's responsibility regarding this resident's elimination status?
A) Place the resident on a preventative catheterization schedule.
B) Provide services and assistance to maintain continence unless a clinical condition makes it
impossible.
C) Limit fluid intake after 6:00 PM for all residents to prevent nighttime accidents.
D) Require the resident to wear adult briefs as a standard precaution.
E) Only assist with toileting if the resident explicitly asks for help.
Correct Answer: B) Provide services and assistance to maintain continence unless a clinical
condition makes it impossible.
Rationale: The goal of person-centered care is to maintain the highest level of function
possible. For a resident who is continent upon admission, the facility must provide the
necessary support (toileting schedules, environmental modifications) to prevent decline into
incontinence. Continence should only be considered "not possible" if a specific clinical
diagnosis or physical/cognitive decline makes it so.
Question 7
Under what circumstances should a resident who entered the facility without an indwelling
catheter be catheterized?
A) When it is more convenient for the staff during busy shifts.
B) Only if the resident's clinical condition demonstrates that catheterization is necessary.
C) If the resident has one episode of urinary incontinence.
D) To collect a routine urine sample for a physical.
E) If the resident requests it to avoid using a bedpan.
Correct Answer: B) Only if the resident's clinical condition demonstrates that
catheterization is necessary.
Rationale: Indwelling catheters are associated with high risks of Urinary Tract Infections
(UTIs) and physical discomfort. Clinical standards dictate that they should not be used as a
treatment for incontinence or for staff convenience. They are reserved for specific medical
needs, such as acute urinary retention or end-of-life comfort when other methods are
ineffective.
Question 8
If a resident is admitted to the facility with an existing indwelling catheter, what is the required
nursing action?
A) Keep the catheter in place indefinitely to prevent leaks.
B) Assess the resident for the removal of the catheter as soon as possible.
C) Change the catheter every 24 hours to ensure sterility.
D) Immediately remove the catheter without a physician’s order.
, 4
E) Encourage the resident to avoid drinking fluids to keep the bag empty.
Correct Answer: B) Assess the resident for the removal of the catheter as soon as possible.
Rationale: Residents admitted with catheters must be evaluated to determine if the medical
necessity for the device still exists. The goal is to remove the catheter as soon as clinically
viable to reduce the risk of infection and promote the resident's independence and physical
well-being. This requires collaboration with the attending physician.
Question 9
For a resident experiencing fecal incontinence, the facility must ensure that the resident receives
appropriate treatment and services to:
A) Ensure they remain in their room at all times.
B) Restore as much normal bowel function as possible.
C) Restrict the resident's fiber intake to slow digestion.
D) Encourage the use of diapers as the only intervention.
E) Only provide care after an accident has occurred.
Correct Answer: B) Restore as much normal bowel function as possible.
Rationale: Fecal incontinence requires a comprehensive assessment of the cause (e.g., diet,
medication, physical mobility). The facility's responsibility is to provide restorative
services, such as bowel training or dietary adjustments, aimed at returning the resident to a
normal or manageable elimination pattern, thereby preserving dignity and skin integrity.
Question 10
In which of the following resident populations is "prompted-voiding" most commonly utilized as
an effective intervention?
A) Residents who are fully independent and continent.
B) Dependent or more cognitively impaired residents who need assistance with toileting.
C) Residents who have a permanent supra-pubic catheter.
D) Residents who are in a comatose state.
E) Residents who are only in the facility for short-term physical therapy.
Correct Answer: B) Dependent or more cognitively impaired residents who need assistance
with toileting.
Rationale: Prompted voiding is a behavioral technique where staff regularly ask residents if
they need to use the bathroom and provide praise or positive reinforcement for successful
voiding. It is specifically designed for residents with cognitive impairments (like dementia)
or physical dependencies who may not recognize or act on the urge to void until it is too
late.
Question 11
The appropriate treatment and services provided to a resident to maintain or improve their ability
to carry out Activities of Daily Living (ADLs) must include which of the following?
A) Only hygiene and mobility.
