NAB CORE EXAM PRACTICE QUESTIONS, ANSWERS, AND DETAILED RATIONALES LATEST STUDY EDITION
Core Domains
• Management, Governance, and Leadership
• Human Resources
• Finance
• Physical Environment and Atmosphere
• Resident Care and Quality of Life
• Federal and State Regulations
Introduction
This practice examination is designed to prepare candidates for the National Association of Long Term Care
Administrator Boards (NAB) Core Examination. The questions assess the knowledge, competencies, and
professional judgment required of entry-level nursing home administrators. Content reflects current federal
regulations, evidence‑based management principles, resident‑centered care, and ethical decision‑making. Each
scenario‑based item challenges the candidate to apply critical thinking, prioritize actions, interpret policies, and
ensure resident safety and quality of life. The format mirrors the actual examination, providing a realistic, timed,
and rigorous self‑assessment tool. Use this resource to identify strengths, focus study efforts, and build confidence
for successful certification.
,SECTION ONE
Questions 1–100
Question 1
A newly admitted resident with moderate dementia repeatedly tries to leave the facility. The care plan team
determines the resident lacks the capacity to understand the risks of elopement. Which intervention should the
administrator approve FIRST?
A. Place a wanderguard bracelet on the resident and install door alarms at all exits.
B. Assign a one-to-one sitter for the resident during all waking hours.
C. Transfer the resident to a locked dementia unit within the facility.
D. Administer a PRN sedative to reduce wandering attempts.
🟢 Correct Answer: A. Place a wanderguard bracelet on the resident and install door alarms at all exits.
🔴 RATIONALE: A wanderguard bracelet and alarmed doors are the least restrictive, most effective initial
measures to prevent unsafe elopement while respecting the resident’s freedom of movement. Federal
regulations (F604) require facilities to use the least restrictive interventions. One‑to‑one supervision (B) is more
restrictive and costly, and should be reserved if environmental interventions fail. Transfer to a locked unit (C) is a
major change requiring medical necessity and resident/representative consent; it is not first‑line. Chemical
,restraint (D) is prohibited unless necessary to treat a medical symptom and only after non-pharmacological
interventions fail.
Question 2
During a state survey, a surveyor observes a certified nursing assistant (CNA) transferring a resident using
improper body mechanics. The CNA has been inserviced on safe transfer techniques twice in the past year.
Which is the administrator’s best immediate action?
A. Terminate the CNA for failure to follow facility policy.
B. Instruct the director of nursing to retrain the CNA immediately.
C. Remove the CNA from resident care duties pending a competency evaluation.
D. Apologize to the surveyor and explain that the CNA is usually careful.
🟢 Correct Answer: C. Remove the CNA from resident care duties pending a competency evaluation.
🔴 RATIONALE: Resident safety is paramount. If a staff member demonstrates unsafe practice despite prior
training, the immediate step is to remove the risk. Suspending the CNA from direct care while evaluating
competency ensures resident protection while allowing an investigation. Termination (A) without due process
may expose the facility to legal risks. Retraining (B) can occur after removal from duty. An apology (D) does not
address the safety risk.
Question 3
, The facility’s operating margin has declined for three consecutive months. The administrator wants to identify
the primary driver without waiting for the month‑end close. Which report provides the most immediate,
actionable data?
A. Balance sheet
B. Statement of cash flows
C. Daily census and revenue flash report
D. Annual budget variance analysis
🟢 Correct Answer: C. Daily census and revenue flash report
🔴 RATIONALE: A daily flash report shows current census, payer mix, and daily revenue, allowing the
administrator to spot occupancy or revenue trends immediately. The balance sheet (A) and statement of cash
flows (B) are lagging indicators produced monthly. The annual budget variance analysis (D) is too high‑level and
infrequent to pinpoint a recent decline.
Question 4
An employee reports to HR that a supervisor repeatedly makes offensive sexual jokes. This is the first complaint
about the supervisor. The administrator’s first responsibility is to:
A. Tell the complaining employee to ignore the jokes.
B. Transfer the employee to a different department.
C. Immediately investigate the complaint and take appropriate corrective action.
D. Terminate the supervisor to avoid a hostile work environment claim.
Core Domains
• Management, Governance, and Leadership
• Human Resources
• Finance
• Physical Environment and Atmosphere
• Resident Care and Quality of Life
• Federal and State Regulations
Introduction
This practice examination is designed to prepare candidates for the National Association of Long Term Care
Administrator Boards (NAB) Core Examination. The questions assess the knowledge, competencies, and
professional judgment required of entry-level nursing home administrators. Content reflects current federal
regulations, evidence‑based management principles, resident‑centered care, and ethical decision‑making. Each
scenario‑based item challenges the candidate to apply critical thinking, prioritize actions, interpret policies, and
ensure resident safety and quality of life. The format mirrors the actual examination, providing a realistic, timed,
and rigorous self‑assessment tool. Use this resource to identify strengths, focus study efforts, and build confidence
for successful certification.
,SECTION ONE
Questions 1–100
Question 1
A newly admitted resident with moderate dementia repeatedly tries to leave the facility. The care plan team
determines the resident lacks the capacity to understand the risks of elopement. Which intervention should the
administrator approve FIRST?
A. Place a wanderguard bracelet on the resident and install door alarms at all exits.
B. Assign a one-to-one sitter for the resident during all waking hours.
C. Transfer the resident to a locked dementia unit within the facility.
D. Administer a PRN sedative to reduce wandering attempts.
🟢 Correct Answer: A. Place a wanderguard bracelet on the resident and install door alarms at all exits.
🔴 RATIONALE: A wanderguard bracelet and alarmed doors are the least restrictive, most effective initial
measures to prevent unsafe elopement while respecting the resident’s freedom of movement. Federal
regulations (F604) require facilities to use the least restrictive interventions. One‑to‑one supervision (B) is more
restrictive and costly, and should be reserved if environmental interventions fail. Transfer to a locked unit (C) is a
major change requiring medical necessity and resident/representative consent; it is not first‑line. Chemical
,restraint (D) is prohibited unless necessary to treat a medical symptom and only after non-pharmacological
interventions fail.
Question 2
During a state survey, a surveyor observes a certified nursing assistant (CNA) transferring a resident using
improper body mechanics. The CNA has been inserviced on safe transfer techniques twice in the past year.
Which is the administrator’s best immediate action?
A. Terminate the CNA for failure to follow facility policy.
B. Instruct the director of nursing to retrain the CNA immediately.
C. Remove the CNA from resident care duties pending a competency evaluation.
D. Apologize to the surveyor and explain that the CNA is usually careful.
🟢 Correct Answer: C. Remove the CNA from resident care duties pending a competency evaluation.
🔴 RATIONALE: Resident safety is paramount. If a staff member demonstrates unsafe practice despite prior
training, the immediate step is to remove the risk. Suspending the CNA from direct care while evaluating
competency ensures resident protection while allowing an investigation. Termination (A) without due process
may expose the facility to legal risks. Retraining (B) can occur after removal from duty. An apology (D) does not
address the safety risk.
Question 3
, The facility’s operating margin has declined for three consecutive months. The administrator wants to identify
the primary driver without waiting for the month‑end close. Which report provides the most immediate,
actionable data?
A. Balance sheet
B. Statement of cash flows
C. Daily census and revenue flash report
D. Annual budget variance analysis
🟢 Correct Answer: C. Daily census and revenue flash report
🔴 RATIONALE: A daily flash report shows current census, payer mix, and daily revenue, allowing the
administrator to spot occupancy or revenue trends immediately. The balance sheet (A) and statement of cash
flows (B) are lagging indicators produced monthly. The annual budget variance analysis (D) is too high‑level and
infrequent to pinpoint a recent decline.
Question 4
An employee reports to HR that a supervisor repeatedly makes offensive sexual jokes. This is the first complaint
about the supervisor. The administrator’s first responsibility is to:
A. Tell the complaining employee to ignore the jokes.
B. Transfer the employee to a different department.
C. Immediately investigate the complaint and take appropriate corrective action.
D. Terminate the supervisor to avoid a hostile work environment claim.
