Missouri Nursing Home Administrator Exam
Official State Healthcare Licensing Board –
2026/2027 Comprehensive Practice
Examination
Instructions: This 200-question examination is designed to prepare candidates for
the Missouri Nursing Home Administrator (NHA) Licensure Exam. Questions are
based on Missouri state regulations (19 CSR 30-85, 19 CSR 30-86, 19 CSR 30-88,
Chapter 198 RSMo), federal regulations (CMS F-tags, 42 CFR Part 483), and NAB
Core and Line of Service (LOS) exam domains
SECTION 1: LEADERSHIP AND GOVERNANCE (Questions 1-40)
Question 1: What is the primary role of a Nursing Home Administrator (NHA) as
defined by federal regulation (CFR 483.70)?
• A. To manage the facility's finances only
• B. The NHA is the licensed individual appointed by the governing body
to be fully responsible for the management of the facility
• C. To supervise only the nursing staff
• D. To handle resident admissions and discharges
Rationale: The NHA is the licensed individual appointed by the governing body to
be fully responsible for the management of the facility, acting in the best interest of
residents, ensuring compliance with all laws, and managing daily operations.
Question 2: Which governing body has the ultimate legal authority and fiduciary
responsibility for a nursing facility?
• A. The Nursing Home Administrator
, • B. The Governing Body (e.g., Board of Directors)
• C. The Medical Director
• D. The Director of Nursing
Rationale: The Governing Body (e.g., Board of Directors) has ultimate legal
authority and fiduciary responsibility. They select the NHA, establish policy, and
ensure the facility's financial viability and regulatory compliance.
Question 3: What is the purpose of a Facility Assessment required under
§483.70(e)?
• A. To evaluate employee performance
• B. To comprehensively identify the specific needs of the resident
population and resources needed to provide care
• C. To assess the facility's financial status
• D. To review marketing strategies
Rationale: The Facility Assessment identifies the specific needs of the resident
population and resources needed to provide care. It drives staffing, training, and
equipment decisions and must be updated annually or when there is a significant
change.
Question 4: What leadership style is most effective in a modern nursing home
environment?
• A. Autocratic leadership
• B. Laissez-faire leadership
• C. Transformational or servant leadership
• D. Transactional leadership
Rationale: A transformational or servant leadership style that empowers staff,
fosters a positive culture, encourages innovation in resident care, and focuses on
,mentorship and team development is generally most effective in modern nursing
home environments.
Question 5: What is "Just Culture" in a healthcare setting?
• A. A system that blames individuals for all errors
• B. A framework that balances accountability with system-based
learning, distinguishing between human error, at-risk behavior, and
reckless conduct
• C. A culture that ignores all errors
• D. A system that punishes all mistakes equally
Rationale: Just Culture is a framework that balances accountability with system-
based learning. It distinguishes between human error, at-risk behavior, and reckless
conduct, focusing on fixing system flaws rather than solely blaming individuals for
errors.
Question 6: Which body has the authority to grant, suspend, or revoke a Missouri
Nursing Home Administrator's license?
• A. Missouri Department of Health and Senior Services
• B. Missouri Board of Nursing Home Administrators
• C. Missouri General Assembly
• D. Centers for Medicare & Medicaid Services (CMS)
Rationale: The Missouri Board of Nursing Home Administrators has the authority
to grant, suspend, or revoke nursing home administrator licenses in Missouri.
Question 7: What are the key components of an effective corporate compliance
program for a skilled nursing facility?
• A. Only written policies and procedures
, • B. Only training and education
• C. Written policies, compliance officer, training, communication,
auditing, enforcement, and corrective action
• D. Only auditing and monitoring
Rationale: An effective corporate compliance program includes: 1) Written
policies and procedures, 2) Designation of a compliance officer, 3) Effective
training and education, 4) Open lines of communication, 5) Auditing and
monitoring, 6) Enforcement and discipline, 7) Corrective action for detected issues.
Question 8: What is the NHA's primary responsibility in a crisis, such as a facility-
wide infectious outbreak?
• A. To close the facility immediately
• B. To implement the emergency preparedness plan, ensure clear
communication, and mobilize resources for resident safety
• C. To send all residents home
• D. To ignore the situation until state authorities arrive
Rationale: The NHA's primary responsibility is to implement the emergency
preparedness plan, ensure clear communication with staff, residents, families, and
public health authorities, and mobilize resources to ensure resident safety and
continuity of operations.
Question 9: Describe the principle of "Fiduciary Duty" as it applies to an NHA.
• A. The NHA must maximize facility profits
• B. The NHA must act in good faith, with loyalty and care, for the
benefit of the residents and the facility
• C. The NHA must only follow state regulations
• D. The NHA must prioritize staff over residents
Official State Healthcare Licensing Board –
2026/2027 Comprehensive Practice
Examination
Instructions: This 200-question examination is designed to prepare candidates for
the Missouri Nursing Home Administrator (NHA) Licensure Exam. Questions are
based on Missouri state regulations (19 CSR 30-85, 19 CSR 30-86, 19 CSR 30-88,
Chapter 198 RSMo), federal regulations (CMS F-tags, 42 CFR Part 483), and NAB
Core and Line of Service (LOS) exam domains
SECTION 1: LEADERSHIP AND GOVERNANCE (Questions 1-40)
Question 1: What is the primary role of a Nursing Home Administrator (NHA) as
defined by federal regulation (CFR 483.70)?
• A. To manage the facility's finances only
• B. The NHA is the licensed individual appointed by the governing body
to be fully responsible for the management of the facility
• C. To supervise only the nursing staff
• D. To handle resident admissions and discharges
Rationale: The NHA is the licensed individual appointed by the governing body to
be fully responsible for the management of the facility, acting in the best interest of
residents, ensuring compliance with all laws, and managing daily operations.
Question 2: Which governing body has the ultimate legal authority and fiduciary
responsibility for a nursing facility?
• A. The Nursing Home Administrator
, • B. The Governing Body (e.g., Board of Directors)
• C. The Medical Director
• D. The Director of Nursing
Rationale: The Governing Body (e.g., Board of Directors) has ultimate legal
authority and fiduciary responsibility. They select the NHA, establish policy, and
ensure the facility's financial viability and regulatory compliance.
Question 3: What is the purpose of a Facility Assessment required under
§483.70(e)?
• A. To evaluate employee performance
• B. To comprehensively identify the specific needs of the resident
population and resources needed to provide care
• C. To assess the facility's financial status
• D. To review marketing strategies
Rationale: The Facility Assessment identifies the specific needs of the resident
population and resources needed to provide care. It drives staffing, training, and
equipment decisions and must be updated annually or when there is a significant
change.
Question 4: What leadership style is most effective in a modern nursing home
environment?
• A. Autocratic leadership
• B. Laissez-faire leadership
• C. Transformational or servant leadership
• D. Transactional leadership
Rationale: A transformational or servant leadership style that empowers staff,
fosters a positive culture, encourages innovation in resident care, and focuses on
,mentorship and team development is generally most effective in modern nursing
home environments.
Question 5: What is "Just Culture" in a healthcare setting?
• A. A system that blames individuals for all errors
• B. A framework that balances accountability with system-based
learning, distinguishing between human error, at-risk behavior, and
reckless conduct
• C. A culture that ignores all errors
• D. A system that punishes all mistakes equally
Rationale: Just Culture is a framework that balances accountability with system-
based learning. It distinguishes between human error, at-risk behavior, and reckless
conduct, focusing on fixing system flaws rather than solely blaming individuals for
errors.
Question 6: Which body has the authority to grant, suspend, or revoke a Missouri
Nursing Home Administrator's license?
• A. Missouri Department of Health and Senior Services
• B. Missouri Board of Nursing Home Administrators
• C. Missouri General Assembly
• D. Centers for Medicare & Medicaid Services (CMS)
Rationale: The Missouri Board of Nursing Home Administrators has the authority
to grant, suspend, or revoke nursing home administrator licenses in Missouri.
Question 7: What are the key components of an effective corporate compliance
program for a skilled nursing facility?
• A. Only written policies and procedures
, • B. Only training and education
• C. Written policies, compliance officer, training, communication,
auditing, enforcement, and corrective action
• D. Only auditing and monitoring
Rationale: An effective corporate compliance program includes: 1) Written
policies and procedures, 2) Designation of a compliance officer, 3) Effective
training and education, 4) Open lines of communication, 5) Auditing and
monitoring, 6) Enforcement and discipline, 7) Corrective action for detected issues.
Question 8: What is the NHA's primary responsibility in a crisis, such as a facility-
wide infectious outbreak?
• A. To close the facility immediately
• B. To implement the emergency preparedness plan, ensure clear
communication, and mobilize resources for resident safety
• C. To send all residents home
• D. To ignore the situation until state authorities arrive
Rationale: The NHA's primary responsibility is to implement the emergency
preparedness plan, ensure clear communication with staff, residents, families, and
public health authorities, and mobilize resources to ensure resident safety and
continuity of operations.
Question 9: Describe the principle of "Fiduciary Duty" as it applies to an NHA.
• A. The NHA must maximize facility profits
• B. The NHA must act in good faith, with loyalty and care, for the
benefit of the residents and the facility
• C. The NHA must only follow state regulations
• D. The NHA must prioritize staff over residents
