NAB NHA Line of Service Exam PA Official Exam
2026/2027 Actual Exam Complete Questions and
Answers Detailed Rationales Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Resident Care and Quality of Life | Q1 – Q10
Section 2 | Pennsylvania State Regulations and Compliance | Q11 – Q20
Section 3 | Human Resources and Staff Management | Q21 – Q30
Section 4 | Financial Management and Operations | Q31 – Q40
Section 5 | Environment, Safety, and Emergency Preparedness | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: RESIDENT CARE AND QUALITY OF LIFE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
An 84-year-old male with moderate dementia residing on the secured unit has refused
breakfast and lunch for two consecutive days. The nurse notes he becomes agitated
when staff try to guide him to the dining room, and he insists on eating in his room
alone. His weight has dropped 4 pounds in the past month.
A. Require the resident to attend meals in the dining room to promote socialization and
monitor intake
B. Honor his preference to eat in his room while assessing for underlying causes such
as pain, oral health issues, or environmental overstimulation ✓ CORRECT
C. Place the resident on a pureed diet to reduce the risk of aspiration during
unsupervised eating
D. Document the refusal and notify the physician only if his weight loss exceeds 5
percent of body weight
,Correct Answer: B
Rationale: Honoring resident preference aligns with person-centered care principles
while the interdisciplinary team investigates reversible causes of appetite decline.
Requiring dining room attendance may increase agitation and further reduce intake in a
resident with dementia. Waiting for a 5 percent weight loss before notifying the
physician delays necessary medical evaluation.
Question 2 of 50
A 78-year-old female admitted three days ago from the hospital presents with a Stage 2
pressure injury on her sacrum. The hospital discharge summary notes she was
bedbound for the final 48 hours of her stay. The wound care nurse evaluates the injury
and finds no signs of infection.
A. Document the injury as hospital-acquired and continue the treatment protocol
initiated at discharge
B. Reclassify the injury as a facility-acquired pressure injury since it was identified after
admission
C. Apply an occlusive hydrocolloid dressing and reassess the wound in 72 hours without
further intervention
D. Initiate a comprehensive skin integrity assessment, risk reassessment, and
individualized prevention plan within 24 hours ✓ CORRECT
Correct Answer: D
Rationale: CMS requires a comprehensive skin assessment and updated prevention
plan within 24 hours of admission regardless of where the injury originated.
Reclassifying it as facility-acquired without evidence is inaccurate and could trigger
unnecessary survey scrutiny. Simply continuing the hospital protocol may miss changes
in the resident's condition or risk factors.
Question 3 of 50
,The daughter of a 76-year-old resident with Parkinson's disease requests that a lap belt
be applied to her mother during wheelchair seating to prevent falls. The resident has
fallen twice in the past month while attempting to stand from her wheelchair, resulting
in minor bruising.
A. Explain that physical restraints require a physician's order, informed consent, and
documented evidence that less restrictive alternatives have been attempted or ruled out
✓ CORRECT
B. Apply the lap belt immediately since the family has provided verbal consent and falls
are a known safety risk
C. Suggest transferring the resident to a fully reclining wheelchair to eliminate the need
for a restraint device
D. Inform the daughter that restraints are prohibited under federal law and cannot be
used under any circumstances
Correct Answer: A
Rationale: Federal regulations permit restraints only when medically necessary, ordered
by a physician, and after less restrictive interventions have been considered. Applying a
restraint based solely on family verbal consent violates resident rights and CMS F-tag
requirements. Stating that restraints are categorically prohibited is incorrect, as they are
allowed under strict regulatory conditions.
Question 4 of 50
A 91-year-old male resident who previously attended daily music therapy sessions has
stopped participating over the last three weeks. Staff report he spends most of the day
in his room with the blinds drawn. His MDS shows no decline in ADLs or cognition, but
he screens positive for social isolation on the PHQ-2.
A. Accept his withdrawal as a normal preference change common among residents of
advanced age
B. Require him to attend at least one group activity per week as part of his care plan
goals
, C. Arrange a one-on-one visit with the activities director to explore his interests and
assess for depression, grief, or environmental barriers ✓ CORRECT
D. Transfer him to a different unit with more active residents to encourage spontaneous
socialization
Correct Answer: C
Rationale: A sudden withdrawal from previously enjoyed activities warrants
individualized assessment for reversible causes such as depression or loss, not
assumptions about age-appropriate behavior. Mandating attendance contradicts
person-centered care and may increase resistance. Transferring units without
understanding the root cause is an unnecessary disruption that does not address the
underlying issue.
Question 5 of 50
During the morning med pass, an LPN discovers that a resident received 20 units of
regular insulin instead of the ordered 10 units. The resident is asymptomatic with a
blood glucose of 142 mg/dL. The LPN reports the error immediately to the charge
nurse.
A. Document the error in the resident's medical record and monitor blood glucose every
15 minutes for the next two hours
B. Initiate the facility's incident reporting protocol, notify the physician and DON, and
increase glucose monitoring per protocol while completing a root-cause analysis ✓
CORRECT
C. Since the resident is asymptomatic, note the variance in the nurse's notes and
continue the standard monitoring schedule
D. Administer a STAT dose of oral glucose to prevent hypoglycemia before it develops
Correct Answer: B
Rationale: Even when a resident is asymptomatic, an insulin overdose requires
immediate physician notification, enhanced monitoring, and structured incident
investigation to prevent recurrence. Documenting the error solely in the medical record
2026/2027 Actual Exam Complete Questions and
Answers Detailed Rationales Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Resident Care and Quality of Life | Q1 – Q10
Section 2 | Pennsylvania State Regulations and Compliance | Q11 – Q20
Section 3 | Human Resources and Staff Management | Q21 – Q30
Section 4 | Financial Management and Operations | Q31 – Q40
Section 5 | Environment, Safety, and Emergency Preparedness | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: RESIDENT CARE AND QUALITY OF LIFE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
An 84-year-old male with moderate dementia residing on the secured unit has refused
breakfast and lunch for two consecutive days. The nurse notes he becomes agitated
when staff try to guide him to the dining room, and he insists on eating in his room
alone. His weight has dropped 4 pounds in the past month.
A. Require the resident to attend meals in the dining room to promote socialization and
monitor intake
B. Honor his preference to eat in his room while assessing for underlying causes such
as pain, oral health issues, or environmental overstimulation ✓ CORRECT
C. Place the resident on a pureed diet to reduce the risk of aspiration during
unsupervised eating
D. Document the refusal and notify the physician only if his weight loss exceeds 5
percent of body weight
,Correct Answer: B
Rationale: Honoring resident preference aligns with person-centered care principles
while the interdisciplinary team investigates reversible causes of appetite decline.
Requiring dining room attendance may increase agitation and further reduce intake in a
resident with dementia. Waiting for a 5 percent weight loss before notifying the
physician delays necessary medical evaluation.
Question 2 of 50
A 78-year-old female admitted three days ago from the hospital presents with a Stage 2
pressure injury on her sacrum. The hospital discharge summary notes she was
bedbound for the final 48 hours of her stay. The wound care nurse evaluates the injury
and finds no signs of infection.
A. Document the injury as hospital-acquired and continue the treatment protocol
initiated at discharge
B. Reclassify the injury as a facility-acquired pressure injury since it was identified after
admission
C. Apply an occlusive hydrocolloid dressing and reassess the wound in 72 hours without
further intervention
D. Initiate a comprehensive skin integrity assessment, risk reassessment, and
individualized prevention plan within 24 hours ✓ CORRECT
Correct Answer: D
Rationale: CMS requires a comprehensive skin assessment and updated prevention
plan within 24 hours of admission regardless of where the injury originated.
Reclassifying it as facility-acquired without evidence is inaccurate and could trigger
unnecessary survey scrutiny. Simply continuing the hospital protocol may miss changes
in the resident's condition or risk factors.
Question 3 of 50
,The daughter of a 76-year-old resident with Parkinson's disease requests that a lap belt
be applied to her mother during wheelchair seating to prevent falls. The resident has
fallen twice in the past month while attempting to stand from her wheelchair, resulting
in minor bruising.
A. Explain that physical restraints require a physician's order, informed consent, and
documented evidence that less restrictive alternatives have been attempted or ruled out
✓ CORRECT
B. Apply the lap belt immediately since the family has provided verbal consent and falls
are a known safety risk
C. Suggest transferring the resident to a fully reclining wheelchair to eliminate the need
for a restraint device
D. Inform the daughter that restraints are prohibited under federal law and cannot be
used under any circumstances
Correct Answer: A
Rationale: Federal regulations permit restraints only when medically necessary, ordered
by a physician, and after less restrictive interventions have been considered. Applying a
restraint based solely on family verbal consent violates resident rights and CMS F-tag
requirements. Stating that restraints are categorically prohibited is incorrect, as they are
allowed under strict regulatory conditions.
Question 4 of 50
A 91-year-old male resident who previously attended daily music therapy sessions has
stopped participating over the last three weeks. Staff report he spends most of the day
in his room with the blinds drawn. His MDS shows no decline in ADLs or cognition, but
he screens positive for social isolation on the PHQ-2.
A. Accept his withdrawal as a normal preference change common among residents of
advanced age
B. Require him to attend at least one group activity per week as part of his care plan
goals
, C. Arrange a one-on-one visit with the activities director to explore his interests and
assess for depression, grief, or environmental barriers ✓ CORRECT
D. Transfer him to a different unit with more active residents to encourage spontaneous
socialization
Correct Answer: C
Rationale: A sudden withdrawal from previously enjoyed activities warrants
individualized assessment for reversible causes such as depression or loss, not
assumptions about age-appropriate behavior. Mandating attendance contradicts
person-centered care and may increase resistance. Transferring units without
understanding the root cause is an unnecessary disruption that does not address the
underlying issue.
Question 5 of 50
During the morning med pass, an LPN discovers that a resident received 20 units of
regular insulin instead of the ordered 10 units. The resident is asymptomatic with a
blood glucose of 142 mg/dL. The LPN reports the error immediately to the charge
nurse.
A. Document the error in the resident's medical record and monitor blood glucose every
15 minutes for the next two hours
B. Initiate the facility's incident reporting protocol, notify the physician and DON, and
increase glucose monitoring per protocol while completing a root-cause analysis ✓
CORRECT
C. Since the resident is asymptomatic, note the variance in the nurse's notes and
continue the standard monitoring schedule
D. Administer a STAT dose of oral glucose to prevent hypoglycemia before it develops
Correct Answer: B
Rationale: Even when a resident is asymptomatic, an insulin overdose requires
immediate physician notification, enhanced monitoring, and structured incident
investigation to prevent recurrence. Documenting the error solely in the medical record
