NAB Core Exam Practice Questions &
Verified Answers for Nursing Home
Administrator Licensing
Question 1
Which of the following would be the best agency to assist a residential facility in
developing its Fire Safety Plan?
A. OSHA
B. NFPA
C. the state survey agency
D. the local fire department
Correct Answer
D. the local fire department
Question 2
On a balance sheet, net accounts receivable is calculated by subtracting which of the
following from gross accounts receivable?
A. allowance for bad debt
B. depreciation expense
C. aging of accounts receivable
D. notes receivable
Correct Answer
A. allowance for bad debt
Question 1: In the context of nursing home administration under federal
regulations, which of the following best describes the primary purpose of the
Resident Assessment Instrument (RAI) process as mandated by CMS for skilled
nursing facilities?
A. To determine the facility’s eligibility for Medicare reimbursement solely based on
staffing ratios
B. To create a standardized method for assessing resident needs, developing care
plans, and monitoring outcomes over time
C. To replace the need for interdisciplinary team meetings and physician oversight
D. To focus exclusively on financial billing codes without regard to clinical status
CORRECT ANSWER: B. To create a standardized method for assessing resident needs,
developing care plans, and monitoring outcomes over time
Rationale: The RAI, which includes the MDS, is a CMS-mandated process designed
to comprehensively assess each resident’s functional, medical, and psychosocial
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,status so that individualized care plans can be developed and outcomes tracked. It
supports quality of care rather than serving as a pure billing or staffing tool.
Question 2: According to OBRA ’87 and subsequent CMS requirements, what is
the minimum frequency at which a comprehensive MDS assessment must be
completed for a long-term care resident who has not experienced a significant
change in status?
A. Every 30 days
B. Every 60 days
C. Every 90 days (quarterly) with an annual comprehensive assessment
D. Only upon admission and discharge
CORRECT ANSWER: C. Every 90 days (quarterly) with an annual comprehensive
assessment
Rationale: Federal regulations require a comprehensive MDS upon admission,
annually, and whenever a significant change in condition occurs. In addition, a
quarterly assessment (or full assessment if indicated) must be completed at least
every 90 days to ensure ongoing monitoring of resident status.
Question 3: Which of the following statements most accurately reflects the
administrator’s responsibility regarding the facility’s Quality Assurance and
Performance Improvement (QAPI) program?
A. QAPI is optional for facilities with five-star ratings and may be delegated entirely
to the director of nursing
B. The administrator must ensure that QAPI is data-driven, involves all departments,
and systematically identifies and corrects performance gaps
C. QAPI activities are limited to infection control and medication error tracking only
D. The medical director has sole responsibility for designing and implementing the
QAPI plan
CORRECT ANSWER: B. The administrator must ensure that QAPI is data-driven,
involves all departments, and systematically identifies and corrects performance gaps
Rationale: CMS requires every nursing facility to maintain an ongoing QAPI
program. The administrator is ultimately accountable for ensuring the program is
facility-wide, uses performance data, engages staff at all levels, and drives
measurable improvement in resident outcomes and organizational processes.
Question 4: Under the Nursing Home Reform Act, which of the following is
considered a resident’s right that cannot be waived by the resident or family?
A. The right to choose a private room at no additional cost
B. The right to be free from chemical and physical restraints imposed for staff
convenience
C. The right to unlimited visitors at any hour without facility policies
D. The right to refuse all medications while still remaining in the facility indefinitely
CORRECT ANSWER: B. The right to be free from chemical and physical restraints
imposed for staff convenience
Rationale: Federal regulations explicitly prohibit the use of restraints for staff
convenience or discipline. This right is fundamental and cannot be waived; any
restraint use must be clinically justified, time-limited, and ordered by a physician
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,with ongoing monitoring.
Question 5: When calculating the facility’s average daily census for budgeting
purposes, which method produces the most accurate figure for projecting
annual occupancy revenue?
A. Using only the highest single-day census of the previous year
B. Dividing total resident days for the period by the number of days in the period
C. Counting only Medicare Part A residents and ignoring private-pay and Medicaid
residents
D. Averaging the census of the three highest-occupancy months only
CORRECT ANSWER: B. Dividing total resident days for the period by the number of
days in the period
Rationale: Average daily census is calculated by summing all resident days (one
resident present for one day equals one resident day) and dividing by the number
of calendar days in the period. This yields a reliable figure for revenue forecasting
and staffing projections.
Question 6: Which of the following is the most appropriate first action an
administrator should take upon learning that a resident has developed a Stage
3 pressure injury that was not present on admission?
A. Immediately discharge the resident to avoid a potential deficiency
B. Ensure a thorough investigation is conducted, the care plan is revised, and the
incident is reported as required under state and federal guidelines
C. Reassign the certified nursing assistants who were on duty without further inquiry
D. Delay notification to the physician until the next scheduled visit
CORRECT ANSWER: B. Ensure a thorough investigation is conducted, the care plan is
revised, and the incident is reported as required under state and federal guidelines
Rationale: Development of a Stage 3 or 4 pressure injury is a significant clinical
event that triggers both internal quality review and, in many jurisdictions,
mandatory reporting. The administrator must ensure prompt clinical response, root-
cause analysis, care-plan updates, and regulatory compliance.
Question 7: In the context of nursing facility financial management, what does
the term “case-mix index” primarily measure?
A. The average age of residents in the facility
B. The relative resource needs of the resident population based on acuity and
clinical conditions
C. The percentage of private-pay versus Medicaid residents
D. The ratio of nursing staff hours to total facility expenses
CORRECT ANSWER: B. The relative resource needs of the resident population based on
acuity and clinical conditions
Rationale: Case-mix index is derived from MDS data and reflects the intensity of
care required by the resident population. Higher case-mix indices generally
correlate with higher reimbursement under prospective payment systems that
adjust for acuity.
Question 8: Which of the following best describes the administrator’s
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, obligation regarding abuse prevention and reporting under federal nursing
home regulations?
A. Only physical abuse must be reported; verbal or psychological abuse may be
handled internally
B. Any allegation of abuse, neglect, or exploitation must be reported immediately to
the appropriate state agency and investigated thoroughly
C. Reporting is required only if the allegation is substantiated by video evidence
D. The administrator may wait up to 72 hours before notifying authorities if the
resident is not in immediate danger
CORRECT ANSWER: B. Any allegation of abuse, neglect, or exploitation must be
reported immediately to the appropriate state agency and investigated thoroughly
Rationale: Federal regulations require immediate reporting of all allegations of
abuse, neglect, mistreatment, or misappropriation of resident property, regardless
of whether the allegation has yet been substantiated. Prompt investigation and
protection of residents are mandatory.
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Verified Answers for Nursing Home
Administrator Licensing
Question 1
Which of the following would be the best agency to assist a residential facility in
developing its Fire Safety Plan?
A. OSHA
B. NFPA
C. the state survey agency
D. the local fire department
Correct Answer
D. the local fire department
Question 2
On a balance sheet, net accounts receivable is calculated by subtracting which of the
following from gross accounts receivable?
A. allowance for bad debt
B. depreciation expense
C. aging of accounts receivable
D. notes receivable
Correct Answer
A. allowance for bad debt
Question 1: In the context of nursing home administration under federal
regulations, which of the following best describes the primary purpose of the
Resident Assessment Instrument (RAI) process as mandated by CMS for skilled
nursing facilities?
A. To determine the facility’s eligibility for Medicare reimbursement solely based on
staffing ratios
B. To create a standardized method for assessing resident needs, developing care
plans, and monitoring outcomes over time
C. To replace the need for interdisciplinary team meetings and physician oversight
D. To focus exclusively on financial billing codes without regard to clinical status
CORRECT ANSWER: B. To create a standardized method for assessing resident needs,
developing care plans, and monitoring outcomes over time
Rationale: The RAI, which includes the MDS, is a CMS-mandated process designed
to comprehensively assess each resident’s functional, medical, and psychosocial
Page 1 of 99
,status so that individualized care plans can be developed and outcomes tracked. It
supports quality of care rather than serving as a pure billing or staffing tool.
Question 2: According to OBRA ’87 and subsequent CMS requirements, what is
the minimum frequency at which a comprehensive MDS assessment must be
completed for a long-term care resident who has not experienced a significant
change in status?
A. Every 30 days
B. Every 60 days
C. Every 90 days (quarterly) with an annual comprehensive assessment
D. Only upon admission and discharge
CORRECT ANSWER: C. Every 90 days (quarterly) with an annual comprehensive
assessment
Rationale: Federal regulations require a comprehensive MDS upon admission,
annually, and whenever a significant change in condition occurs. In addition, a
quarterly assessment (or full assessment if indicated) must be completed at least
every 90 days to ensure ongoing monitoring of resident status.
Question 3: Which of the following statements most accurately reflects the
administrator’s responsibility regarding the facility’s Quality Assurance and
Performance Improvement (QAPI) program?
A. QAPI is optional for facilities with five-star ratings and may be delegated entirely
to the director of nursing
B. The administrator must ensure that QAPI is data-driven, involves all departments,
and systematically identifies and corrects performance gaps
C. QAPI activities are limited to infection control and medication error tracking only
D. The medical director has sole responsibility for designing and implementing the
QAPI plan
CORRECT ANSWER: B. The administrator must ensure that QAPI is data-driven,
involves all departments, and systematically identifies and corrects performance gaps
Rationale: CMS requires every nursing facility to maintain an ongoing QAPI
program. The administrator is ultimately accountable for ensuring the program is
facility-wide, uses performance data, engages staff at all levels, and drives
measurable improvement in resident outcomes and organizational processes.
Question 4: Under the Nursing Home Reform Act, which of the following is
considered a resident’s right that cannot be waived by the resident or family?
A. The right to choose a private room at no additional cost
B. The right to be free from chemical and physical restraints imposed for staff
convenience
C. The right to unlimited visitors at any hour without facility policies
D. The right to refuse all medications while still remaining in the facility indefinitely
CORRECT ANSWER: B. The right to be free from chemical and physical restraints
imposed for staff convenience
Rationale: Federal regulations explicitly prohibit the use of restraints for staff
convenience or discipline. This right is fundamental and cannot be waived; any
restraint use must be clinically justified, time-limited, and ordered by a physician
Page 2 of 99
,with ongoing monitoring.
Question 5: When calculating the facility’s average daily census for budgeting
purposes, which method produces the most accurate figure for projecting
annual occupancy revenue?
A. Using only the highest single-day census of the previous year
B. Dividing total resident days for the period by the number of days in the period
C. Counting only Medicare Part A residents and ignoring private-pay and Medicaid
residents
D. Averaging the census of the three highest-occupancy months only
CORRECT ANSWER: B. Dividing total resident days for the period by the number of
days in the period
Rationale: Average daily census is calculated by summing all resident days (one
resident present for one day equals one resident day) and dividing by the number
of calendar days in the period. This yields a reliable figure for revenue forecasting
and staffing projections.
Question 6: Which of the following is the most appropriate first action an
administrator should take upon learning that a resident has developed a Stage
3 pressure injury that was not present on admission?
A. Immediately discharge the resident to avoid a potential deficiency
B. Ensure a thorough investigation is conducted, the care plan is revised, and the
incident is reported as required under state and federal guidelines
C. Reassign the certified nursing assistants who were on duty without further inquiry
D. Delay notification to the physician until the next scheduled visit
CORRECT ANSWER: B. Ensure a thorough investigation is conducted, the care plan is
revised, and the incident is reported as required under state and federal guidelines
Rationale: Development of a Stage 3 or 4 pressure injury is a significant clinical
event that triggers both internal quality review and, in many jurisdictions,
mandatory reporting. The administrator must ensure prompt clinical response, root-
cause analysis, care-plan updates, and regulatory compliance.
Question 7: In the context of nursing facility financial management, what does
the term “case-mix index” primarily measure?
A. The average age of residents in the facility
B. The relative resource needs of the resident population based on acuity and
clinical conditions
C. The percentage of private-pay versus Medicaid residents
D. The ratio of nursing staff hours to total facility expenses
CORRECT ANSWER: B. The relative resource needs of the resident population based on
acuity and clinical conditions
Rationale: Case-mix index is derived from MDS data and reflects the intensity of
care required by the resident population. Higher case-mix indices generally
correlate with higher reimbursement under prospective payment systems that
adjust for acuity.
Question 8: Which of the following best describes the administrator’s
Page 3 of 99
, obligation regarding abuse prevention and reporting under federal nursing
home regulations?
A. Only physical abuse must be reported; verbal or psychological abuse may be
handled internally
B. Any allegation of abuse, neglect, or exploitation must be reported immediately to
the appropriate state agency and investigated thoroughly
C. Reporting is required only if the allegation is substantiated by video evidence
D. The administrator may wait up to 72 hours before notifying authorities if the
resident is not in immediate danger
CORRECT ANSWER: B. Any allegation of abuse, neglect, or exploitation must be
reported immediately to the appropriate state agency and investigated thoroughly
Rationale: Federal regulations require immediate reporting of all allegations of
abuse, neglect, mistreatment, or misappropriation of resident property, regardless
of whether the allegation has yet been substantiated. Prompt investigation and
protection of residents are mandatory.
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