NC Assisted Living Administrator State Exam 2026:
100 Practice Questions & Correct Answers | Complete
Exam Prep Guide
1. Which North Carolina agency is responsible for regulating licensed adult care homes
through the Adult Care Licensure Section?
A. North Carolina Department of Labor
B. North Carolina Department of Health and Human Services
C. North Carolina Board of Nursing
D. North Carolina Department of Insurance
Correct Answer: B
Rationale: The North Carolina Department of Health and Human Services (NCDHHS), through
the Division of Health Service Regulation (DHSR), Adult Care Licensure Section (ACLS),
regulates adult care homes.
2. What is the primary responsibility of an adult care home administrator?
A. Perform all resident personal-care tasks personally
B. Manage the facility and ensure compliance with applicable laws and regulations
C. Prescribe medications for residents
D. Replace the resident's physician
Correct Answer: B
Rationale: The administrator is responsible for overall facility operation and compliance. The
administrator does not function as a physician or personally perform every direct-care task.
3. Which of the following is considered an activity of daily living (ADL) under North
Carolina adult-care-home rules?
A. Financial investing
B. Bathing
C. Transportation planning
D. Purchasing insurance
Correct Answer: B
,Rationale: ADLs include activities such as eating, dressing, bathing, toileting, bowel and
bladder control, transfers, ambulation, and communication.
4. A resident suddenly develops confusion and a significant change from their normal
condition. What should the administrator expect staff to do first?
A. Ignore it until the next scheduled assessment
B. Treat the change as potentially significant and initiate appropriate assessment/reporting
procedures
C. Immediately discharge the resident
D. Tell the family that nothing can be done
Correct Answer: B
Rationale: A sudden change in condition may represent an acute care need. Staff should
recognize changes from baseline and follow appropriate assessment, notification, documentation,
and medical-response procedures.
5. When an administrator is absent from an adult care home, who may be designated to
handle day-to-day operations?
A. Any resident
B. A designated qualified manager
C. A visitor
D. Any employee regardless of qualifications
Correct Answer: B
Rationale: North Carolina rules provide for a manager to carry out day-to-day operations when
the administrator is absent. The administrator remains ultimately responsible, and the manager
operates under the administrator's direction and supervision.
6. Which statement best describes the role of the manager when the administrator is
absent?
A. The manager becomes permanently responsible for the facility
B. The manager carries out day-to-day operations under the administrator's direction and
supervision
C. The manager may disregard facility policies
D. The manager becomes the resident's legal guardian
,Correct Answer: B
Rationale: The manager's role is to maintain day-to-day operations during the administrator's
absence. The administrator remains ultimately responsible for the adult care home.
7. Which of the following is an example of resident exploitation?
A. Helping a resident select clothing
B. Using a resident's money for the employee's personal benefit
C. Assisting a resident with bathing
D. Helping a resident participate in an activity
Correct Answer: B
Rationale: Exploitation involves improper use of another person's resources or property for
personal benefit. Administrators must establish safeguards against financial exploitation.
8. A staff member reports suspected physical abuse of a resident by another employee.
What should the administrator do?
A. Tell the staff member to forget about it
B. Follow required reporting, protection, investigation, and documentation procedures
C. Wait until the annual inspection
D. Delete the employee's personnel file
Correct Answer: B
Rationale: Suspected abuse must be taken seriously. The administrator's responsibility includes
protecting the resident, following applicable reporting requirements, documenting the concern,
and taking appropriate action.
9. Which principle is most consistent with quality adult-care services?
A. Maximizing restrictions on residents
B. Promoting resident dignity, privacy, autonomy, independence, and safety
C. Allowing staff to make all decisions
D. Eliminating resident choices
Correct Answer: B
, Rationale: North Carolina's adult-care training framework emphasizes quality of life, autonomy,
privacy, independence, respect, and dignity for residents.
10. A resident refuses assistance with bathing. What is the BEST initial approach?
A. Force the resident to bathe
B. Respect the resident's rights while determining why the resident is refusing and following the
care plan and applicable procedures
C. Threaten discharge
D. Call law enforcement immediately
Correct Answer: B
Rationale: Residents retain rights and dignity. Staff should explore the reason for refusal, assess
for potential health or safety concerns, and follow the resident's care plan and applicable facility
procedures.
11. Which situation requires particularly careful documentation by the administrator?
A. A resident participates in a normal recreational activity
B. A significant change in resident condition
C. Staff taking a scheduled lunch break
D. A routine weather forecast
Correct Answer: B
Rationale: Significant changes in condition can affect resident safety and care. Accurate
documentation supports communication, continuity of care, and regulatory compliance.
12. What is the BEST reason for maintaining accurate resident records?
A. To increase paperwork
B. To support safe, coordinated care and demonstrate compliance
C. To replace verbal communication entirely
D. To make inspections longer
Correct Answer: B
Rationale: Accurate records provide an ongoing account of resident needs, services provided,
changes in condition, and actions taken. They are also important during regulatory review.
100 Practice Questions & Correct Answers | Complete
Exam Prep Guide
1. Which North Carolina agency is responsible for regulating licensed adult care homes
through the Adult Care Licensure Section?
A. North Carolina Department of Labor
B. North Carolina Department of Health and Human Services
C. North Carolina Board of Nursing
D. North Carolina Department of Insurance
Correct Answer: B
Rationale: The North Carolina Department of Health and Human Services (NCDHHS), through
the Division of Health Service Regulation (DHSR), Adult Care Licensure Section (ACLS),
regulates adult care homes.
2. What is the primary responsibility of an adult care home administrator?
A. Perform all resident personal-care tasks personally
B. Manage the facility and ensure compliance with applicable laws and regulations
C. Prescribe medications for residents
D. Replace the resident's physician
Correct Answer: B
Rationale: The administrator is responsible for overall facility operation and compliance. The
administrator does not function as a physician or personally perform every direct-care task.
3. Which of the following is considered an activity of daily living (ADL) under North
Carolina adult-care-home rules?
A. Financial investing
B. Bathing
C. Transportation planning
D. Purchasing insurance
Correct Answer: B
,Rationale: ADLs include activities such as eating, dressing, bathing, toileting, bowel and
bladder control, transfers, ambulation, and communication.
4. A resident suddenly develops confusion and a significant change from their normal
condition. What should the administrator expect staff to do first?
A. Ignore it until the next scheduled assessment
B. Treat the change as potentially significant and initiate appropriate assessment/reporting
procedures
C. Immediately discharge the resident
D. Tell the family that nothing can be done
Correct Answer: B
Rationale: A sudden change in condition may represent an acute care need. Staff should
recognize changes from baseline and follow appropriate assessment, notification, documentation,
and medical-response procedures.
5. When an administrator is absent from an adult care home, who may be designated to
handle day-to-day operations?
A. Any resident
B. A designated qualified manager
C. A visitor
D. Any employee regardless of qualifications
Correct Answer: B
Rationale: North Carolina rules provide for a manager to carry out day-to-day operations when
the administrator is absent. The administrator remains ultimately responsible, and the manager
operates under the administrator's direction and supervision.
6. Which statement best describes the role of the manager when the administrator is
absent?
A. The manager becomes permanently responsible for the facility
B. The manager carries out day-to-day operations under the administrator's direction and
supervision
C. The manager may disregard facility policies
D. The manager becomes the resident's legal guardian
,Correct Answer: B
Rationale: The manager's role is to maintain day-to-day operations during the administrator's
absence. The administrator remains ultimately responsible for the adult care home.
7. Which of the following is an example of resident exploitation?
A. Helping a resident select clothing
B. Using a resident's money for the employee's personal benefit
C. Assisting a resident with bathing
D. Helping a resident participate in an activity
Correct Answer: B
Rationale: Exploitation involves improper use of another person's resources or property for
personal benefit. Administrators must establish safeguards against financial exploitation.
8. A staff member reports suspected physical abuse of a resident by another employee.
What should the administrator do?
A. Tell the staff member to forget about it
B. Follow required reporting, protection, investigation, and documentation procedures
C. Wait until the annual inspection
D. Delete the employee's personnel file
Correct Answer: B
Rationale: Suspected abuse must be taken seriously. The administrator's responsibility includes
protecting the resident, following applicable reporting requirements, documenting the concern,
and taking appropriate action.
9. Which principle is most consistent with quality adult-care services?
A. Maximizing restrictions on residents
B. Promoting resident dignity, privacy, autonomy, independence, and safety
C. Allowing staff to make all decisions
D. Eliminating resident choices
Correct Answer: B
, Rationale: North Carolina's adult-care training framework emphasizes quality of life, autonomy,
privacy, independence, respect, and dignity for residents.
10. A resident refuses assistance with bathing. What is the BEST initial approach?
A. Force the resident to bathe
B. Respect the resident's rights while determining why the resident is refusing and following the
care plan and applicable procedures
C. Threaten discharge
D. Call law enforcement immediately
Correct Answer: B
Rationale: Residents retain rights and dignity. Staff should explore the reason for refusal, assess
for potential health or safety concerns, and follow the resident's care plan and applicable facility
procedures.
11. Which situation requires particularly careful documentation by the administrator?
A. A resident participates in a normal recreational activity
B. A significant change in resident condition
C. Staff taking a scheduled lunch break
D. A routine weather forecast
Correct Answer: B
Rationale: Significant changes in condition can affect resident safety and care. Accurate
documentation supports communication, continuity of care, and regulatory compliance.
12. What is the BEST reason for maintaining accurate resident records?
A. To increase paperwork
B. To support safe, coordinated care and demonstrate compliance
C. To replace verbal communication entirely
D. To make inspections longer
Correct Answer: B
Rationale: Accurate records provide an ongoing account of resident needs, services provided,
changes in condition, and actions taken. They are also important during regulatory review.
