Texas Nursing Home Administrator License Exam: (Latest
2026/2027 ) 50 Questions & Answers with Detailed
Rationales | Grade A
PREPARED FOR:
Texas Nursing Home Administrator License Examination – HHSC
DOCUMENT INCLUDES:
● Practice exam questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Federal Regulations (CMS F-Tags & Requirements of Participation)
● Texas State Regulations (HHSC Rules & Texas Health and Safety Code)
● Resident Rights, Quality of Life & Admission/Discharge
● Resident Assessment & Care Planning (MDS 3.0)
● Clinical Care Oversight, Medication Management & Infection Control
● Dietary/Nutrition Services & Social Services/Activities
● Physical Environment, Safety & Emergency Preparedness
● Staffing, Human Resources & Training Competency
● Financial Management, Budgeting & Reimbursement (Medicaid/Medicare)
● Records Management, HIPAA & Survey Process
● Abuse/Neglect Reporting & Ethics
PURPOSE:
,This comprehensive practice test is designed to help nursing home administrator
candidates master Texas regulatory requirements, understand facility management
principles, and confidently prepare for the Texas NHA Licensure Examination.
SECTION 1: Federal Regulations (CMS F-Tags & Requirements of Participation)
Question 1
A new resident has refused physical therapy for three consecutive sessions. The
Director of Nursing insists the resident must attend because therapy is in the care plan.
As the nursing home administrator, what is your responsibility under CMS federal
regulations?
A. Support the Director of Nursing and require the resident to attend therapy
B. Respect the resident's right to refuse treatment, inform the resident of consequences,
and document the refusal
C. Discharge the resident for noncompliance with the plan of care
D. Ask the resident's family to sign a waiver overriding the refusal
Correct Answer: B
Rationale: Under CMS F242 (Resident Rights), residents have the fundamental right to
refuse treatment, care, and services. The facility must inform the resident of the medical
consequences of refusal but cannot force treatment, coerce the resident, or discharge
them solely for exercising this right. Option A violates resident rights. Option C is
prohibited because refusal of treatment is not a valid basis for discharge. Option D is
,inappropriate because family members cannot override a competent resident's
decision, and a waiver does not negate the resident's rights.
Question 2
During a quarterly medication regimen review, the consultant pharmacist identifies that
a resident has been on a benzodiazepine for 8 months without a documented clinical
indication. Which CMS F-tag directly addresses this concern?
A. F329 – Unnecessary Drugs
B. F425 – Pharmacy Services
C. F309 – Quality of Care
D. F686 – Pressure Injuries
Correct Answer: A
Rationale: F329 specifically addresses unnecessary drugs, requiring that each resident's
medication regimen be free from unnecessary medications, including those without
documented indication, those used in excessive dose or duration, and those with
adverse consequences. The regulation requires gradual dose reduction and behavioral
interventions unless clinically contraindicated. While F425 covers pharmacy services
and F309 covers quality of care broadly, F329 is the specific tag for unnecessary drug
concerns. F686 is unrelated to medication management.
Question 3
A nurse aide reports witnessing a staff member roughly handling a resident. Under CMS
federal regulations (42 CFR 483.12), within what timeframe must the facility report this
, allegation to the state survey agency and law enforcement if serious bodily injury is
suspected?
A. Within 24 hours
B. Within 2 hours
C. Within 1 hour
D. Immediately, with no specific timeframe required
Correct Answer: B
Rationale: Under 42 CFR 483.12(c), the facility must report all alleged violations of
abuse, neglect, misappropriation of resident property, or exploitation to the State Survey
Agency and to law enforcement. If serious bodily injury is suspected, the report must be
made within 2 hours. For all other allegations, the report must be made within 24 hours.
The facility must also conduct its own investigation. Option A applies when serious
bodily injury is not suspected. Option C reflects the stricter Texas state requirement, not
the federal timeframe. Option D is incorrect because specific timeframes are mandated.
Question 4
A facility is cited during a standard survey for inadequate nursing staff to meet resident
needs. Which CMS F-tag is most likely cited?
A. F353 – Nursing Services
B. F620 – Admission and Transfer Rights
C. F725 – Quality Assurance and Performance Improvement
D. F742 – Pain Management
2026/2027 ) 50 Questions & Answers with Detailed
Rationales | Grade A
PREPARED FOR:
Texas Nursing Home Administrator License Examination – HHSC
DOCUMENT INCLUDES:
● Practice exam questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Federal Regulations (CMS F-Tags & Requirements of Participation)
● Texas State Regulations (HHSC Rules & Texas Health and Safety Code)
● Resident Rights, Quality of Life & Admission/Discharge
● Resident Assessment & Care Planning (MDS 3.0)
● Clinical Care Oversight, Medication Management & Infection Control
● Dietary/Nutrition Services & Social Services/Activities
● Physical Environment, Safety & Emergency Preparedness
● Staffing, Human Resources & Training Competency
● Financial Management, Budgeting & Reimbursement (Medicaid/Medicare)
● Records Management, HIPAA & Survey Process
● Abuse/Neglect Reporting & Ethics
PURPOSE:
,This comprehensive practice test is designed to help nursing home administrator
candidates master Texas regulatory requirements, understand facility management
principles, and confidently prepare for the Texas NHA Licensure Examination.
SECTION 1: Federal Regulations (CMS F-Tags & Requirements of Participation)
Question 1
A new resident has refused physical therapy for three consecutive sessions. The
Director of Nursing insists the resident must attend because therapy is in the care plan.
As the nursing home administrator, what is your responsibility under CMS federal
regulations?
A. Support the Director of Nursing and require the resident to attend therapy
B. Respect the resident's right to refuse treatment, inform the resident of consequences,
and document the refusal
C. Discharge the resident for noncompliance with the plan of care
D. Ask the resident's family to sign a waiver overriding the refusal
Correct Answer: B
Rationale: Under CMS F242 (Resident Rights), residents have the fundamental right to
refuse treatment, care, and services. The facility must inform the resident of the medical
consequences of refusal but cannot force treatment, coerce the resident, or discharge
them solely for exercising this right. Option A violates resident rights. Option C is
prohibited because refusal of treatment is not a valid basis for discharge. Option D is
,inappropriate because family members cannot override a competent resident's
decision, and a waiver does not negate the resident's rights.
Question 2
During a quarterly medication regimen review, the consultant pharmacist identifies that
a resident has been on a benzodiazepine for 8 months without a documented clinical
indication. Which CMS F-tag directly addresses this concern?
A. F329 – Unnecessary Drugs
B. F425 – Pharmacy Services
C. F309 – Quality of Care
D. F686 – Pressure Injuries
Correct Answer: A
Rationale: F329 specifically addresses unnecessary drugs, requiring that each resident's
medication regimen be free from unnecessary medications, including those without
documented indication, those used in excessive dose or duration, and those with
adverse consequences. The regulation requires gradual dose reduction and behavioral
interventions unless clinically contraindicated. While F425 covers pharmacy services
and F309 covers quality of care broadly, F329 is the specific tag for unnecessary drug
concerns. F686 is unrelated to medication management.
Question 3
A nurse aide reports witnessing a staff member roughly handling a resident. Under CMS
federal regulations (42 CFR 483.12), within what timeframe must the facility report this
, allegation to the state survey agency and law enforcement if serious bodily injury is
suspected?
A. Within 24 hours
B. Within 2 hours
C. Within 1 hour
D. Immediately, with no specific timeframe required
Correct Answer: B
Rationale: Under 42 CFR 483.12(c), the facility must report all alleged violations of
abuse, neglect, misappropriation of resident property, or exploitation to the State Survey
Agency and to law enforcement. If serious bodily injury is suspected, the report must be
made within 2 hours. For all other allegations, the report must be made within 24 hours.
The facility must also conduct its own investigation. Option A applies when serious
bodily injury is not suspected. Option C reflects the stricter Texas state requirement, not
the federal timeframe. Option D is incorrect because specific timeframes are mandated.
Question 4
A facility is cited during a standard survey for inadequate nursing staff to meet resident
needs. Which CMS F-tag is most likely cited?
A. F353 – Nursing Services
B. F620 – Admission and Transfer Rights
C. F725 – Quality Assurance and Performance Improvement
D. F742 – Pain Management
