MARYLAND NURSING
HOME
ADMINISTRATORS
BOARD EXAM: ELITE
UNIVERSAL TEST BANK
PART 0: TABLE OF CONTENTS
1. PART I: THE PREVIEW
2. PART II: THE ELITE TEST BANK
○ Tier 1: Foundational Syntax & Application (Questions 1–18)
○ Tier 2: Complex Application & Simulation (Questions 19–37)
○ Tier 3: Grandmaster Synthesis (Questions 38–55)
PART I: THE PREVIEW
Mastery of this specialized assessment translates directly into clinical and operational
dominance across the Maryland long-term care sector. By isolating the exact regulatory and
administrative thresholds mandated by COMAR and CMS, this gauntlet forges intuitive,
high-level executive decision-making.
The "Critical Axioms" Cheat Sheet
● The Staffing Floor: COMAR 10.07.02.19 mandates a minimum of 3.0 hours of bedside
care per occupied bed per day, with the ratio of bedside personnel to residents never
falling below 1:15 at any time.
● The 80/60 Area Law: Resident bedrooms must provide a minimum of 80 usable square
feet for single occupancy and 60 square feet per bed for multiple occupancy, maxing at
four residents.
● The 30-Day Transition Mandate: Involuntary discharges require a strict 30-day written
notice, except in absolute emergencies or when the resident has resided in the facility for
fewer than 30 days.
● The 48-Hour Prime Mover Standard: Emergency generators must transfer load within
10 seconds, maintain a 48-hour on-site fuel supply, and undergo 30-minute monthly tests.
● The Delegation Loop: Under COMAR 10.27.11, only a Registered Nurse (RN) may
delegate nursing functions to unlicensed personnel, requiring a mandatory on-site review
every 45 days.
,PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: Under COMAR 10.07.02.19, an administrator is evaluating the 24-hour staffing schedule.
Based on the principles of Minimum Bedside Care, which calculation represents the
UNEQUIVOCALLY CORRECT mandate? A) 3.2 hours of bedside care per occupied bed per
day, matching California state regulatory standards. B) 2.5 hours of bedside care per occupied
bed per day, with a 1:20 minimum ratio. C) 3.0 hours of bedside care per occupied bed per day,
with the ratio never dropping below 1:15. D) 3.5 hours of bedside care per occupied bed per
day, excluding the Director of Nursing's time.
● Answer: C (3.0 hours of bedside care per occupied bed per day, with the ratio never
dropping below 1:15.)
● Distractor Analysis:
○ A is incorrect: This applies an out-of-state legacy standard rather than current
Maryland COMAR regulations.
○ B is incorrect: This falls below the strict Maryland threshold of 3.0 hours and
violates the 1:15 maximum ratio.
○ D is incorrect: The Director of Nursing's time can be counted if they are providing
direct bedside care.
The Mentor's Analysis: Maryland rigidly enforces the 3.0 hours per resident day (HPRD)
baseline alongside a hard-deck 1:15 staffing ratio on all shifts.
Metric COMAR Requirement Exclusions
Daily Bedside Care 3.0 hours/bed/day Non-bedside administrative
hours
Minimum Shift Ratio 1:15 personnel-to-resident Ancillary staff (e.g., dietary)
When facing staffing audits, the
immediate priority is verifying
that both aggregate hours and
shift-specific ratios comply. By
utilizing real-time roster
tracking, you bypass the
common trap of failing the
shift-ratio rule even if the
24-hour aggregate is met.
Professional Intuition:
Aggregate hours do not
excuse shift-specific ratio
failures; both must be
satisfied concurrently.
Q2: A facility is constructing a new residential wing. Based on the principles of Physical Plant
Requirements, what is the MINIMUM required floor space for a double-occupancy room? A) 100
square feet total. B) 200 square feet total. C) 120 square feet total. D) 160 square feet total.
● Answer: C (120 square feet total.)
● Distractor Analysis:
○ A is incorrect: This underestimates the required 60 square feet per bed for
, multiple-occupancy rooms.
○ B is incorrect: This applies an outdated standard for specialized rehabilitation
spaces.
○ D is incorrect: This erroneously doubles the single-occupancy requirement of 80
square feet instead of using the multiple-occupancy metric.
The Mentor's Analysis: COMAR dictates 80 square feet for single rooms and 60 square feet per
bed for multiple occupancy. When facing construction or remodeling, the immediate priority is
calculating usable square feet. By utilizing the 60 sq ft/bed metric, you bypass the common trap
of including closets, vestibules, and door swing areas in the calculation. Professional Intuition:
Usable space excludes service areas, door swings, and closets; calculate solely on open,
accessible flooring.
Q3: Following an unexpected utility failure, a facility loses municipal power. Based on the
principles of Emergency and Disaster Planning, what is the FIRST performance requirement the
emergency generator must meet? A) Provide a minimum of 72 hours of uninterrupted power. B)
Be tested immediately for 30 minutes under load. C) Maintain a temperature of 75°F in all
common areas of refuge. D) Come to full speed and load acceptance within 10 seconds.
● Answer: D (Come to full speed and load acceptance within 10 seconds.)
● Distractor Analysis:
○ A is incorrect: COMAR requires a 48-hour capacity from on-site fuel, not 72 hours.
○ B is incorrect: The 30-minute test is a routine monthly maintenance requirement,
not an immediate post-failure directive.
○ C is incorrect: The minimum temperature requirement for common areas of refuge
is 71°F, not 75°F.
The Mentor's Analysis: Life Safety Codes and COMAR require an immediate transition to
emergency power to support life-sustaining equipment. When facing a power outage, the
immediate priority is ensuring load acceptance within 10 seconds. By utilizing automatic transfer
switches, you bypass the common trap of relying on manual overrides during critical failures.
Professional Intuition: The 10-second load acceptance is a non-negotiable life-safety
standard designed to prevent anoxic events in ventilator-dependent residents.
Q4: An administrator is hiring a new Medical Director. Based on the principles of Medical
Director Qualifications, which candidate is the MOST APPROPRIATE choice under Maryland
law? A) A licensed physician with 1 year of clinical experience in an acute hospital. B) A
registered nurse practitioner with 5 years of geriatric care experience. C) A licensed physician
with 3 years of experience in the medical care of geriatric or chronically ill residents. D) A
licensed physician with 10 years of pediatric experience.
● Answer: C (A licensed physician with 3 years of experience in the medical care of geriatric
or chronically ill residents.)
● Distractor Analysis:
○ A is incorrect: COMAR requires at least 2 years of experience or specialized
training in geriatric or chronic care.
○ B is incorrect: The Medical Director must hold a current license as a physician in
the state, not an NP license.
○ D is incorrect: Pediatric experience does not satisfy the geriatric or chronically ill
experience mandate.
The Mentor's Analysis: The Medical Director establishes clinical policy and oversees attending
physicians. When facing executive hiring, the immediate priority is verifying the 2-year geriatric
or chronic care threshold. By utilizing specialized geriatricians, you bypass the common trap of
appointing highly experienced but contextually unsuited practitioners. Professional Intuition:
HOME
ADMINISTRATORS
BOARD EXAM: ELITE
UNIVERSAL TEST BANK
PART 0: TABLE OF CONTENTS
1. PART I: THE PREVIEW
2. PART II: THE ELITE TEST BANK
○ Tier 1: Foundational Syntax & Application (Questions 1–18)
○ Tier 2: Complex Application & Simulation (Questions 19–37)
○ Tier 3: Grandmaster Synthesis (Questions 38–55)
PART I: THE PREVIEW
Mastery of this specialized assessment translates directly into clinical and operational
dominance across the Maryland long-term care sector. By isolating the exact regulatory and
administrative thresholds mandated by COMAR and CMS, this gauntlet forges intuitive,
high-level executive decision-making.
The "Critical Axioms" Cheat Sheet
● The Staffing Floor: COMAR 10.07.02.19 mandates a minimum of 3.0 hours of bedside
care per occupied bed per day, with the ratio of bedside personnel to residents never
falling below 1:15 at any time.
● The 80/60 Area Law: Resident bedrooms must provide a minimum of 80 usable square
feet for single occupancy and 60 square feet per bed for multiple occupancy, maxing at
four residents.
● The 30-Day Transition Mandate: Involuntary discharges require a strict 30-day written
notice, except in absolute emergencies or when the resident has resided in the facility for
fewer than 30 days.
● The 48-Hour Prime Mover Standard: Emergency generators must transfer load within
10 seconds, maintain a 48-hour on-site fuel supply, and undergo 30-minute monthly tests.
● The Delegation Loop: Under COMAR 10.27.11, only a Registered Nurse (RN) may
delegate nursing functions to unlicensed personnel, requiring a mandatory on-site review
every 45 days.
,PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: Under COMAR 10.07.02.19, an administrator is evaluating the 24-hour staffing schedule.
Based on the principles of Minimum Bedside Care, which calculation represents the
UNEQUIVOCALLY CORRECT mandate? A) 3.2 hours of bedside care per occupied bed per
day, matching California state regulatory standards. B) 2.5 hours of bedside care per occupied
bed per day, with a 1:20 minimum ratio. C) 3.0 hours of bedside care per occupied bed per day,
with the ratio never dropping below 1:15. D) 3.5 hours of bedside care per occupied bed per
day, excluding the Director of Nursing's time.
● Answer: C (3.0 hours of bedside care per occupied bed per day, with the ratio never
dropping below 1:15.)
● Distractor Analysis:
○ A is incorrect: This applies an out-of-state legacy standard rather than current
Maryland COMAR regulations.
○ B is incorrect: This falls below the strict Maryland threshold of 3.0 hours and
violates the 1:15 maximum ratio.
○ D is incorrect: The Director of Nursing's time can be counted if they are providing
direct bedside care.
The Mentor's Analysis: Maryland rigidly enforces the 3.0 hours per resident day (HPRD)
baseline alongside a hard-deck 1:15 staffing ratio on all shifts.
Metric COMAR Requirement Exclusions
Daily Bedside Care 3.0 hours/bed/day Non-bedside administrative
hours
Minimum Shift Ratio 1:15 personnel-to-resident Ancillary staff (e.g., dietary)
When facing staffing audits, the
immediate priority is verifying
that both aggregate hours and
shift-specific ratios comply. By
utilizing real-time roster
tracking, you bypass the
common trap of failing the
shift-ratio rule even if the
24-hour aggregate is met.
Professional Intuition:
Aggregate hours do not
excuse shift-specific ratio
failures; both must be
satisfied concurrently.
Q2: A facility is constructing a new residential wing. Based on the principles of Physical Plant
Requirements, what is the MINIMUM required floor space for a double-occupancy room? A) 100
square feet total. B) 200 square feet total. C) 120 square feet total. D) 160 square feet total.
● Answer: C (120 square feet total.)
● Distractor Analysis:
○ A is incorrect: This underestimates the required 60 square feet per bed for
, multiple-occupancy rooms.
○ B is incorrect: This applies an outdated standard for specialized rehabilitation
spaces.
○ D is incorrect: This erroneously doubles the single-occupancy requirement of 80
square feet instead of using the multiple-occupancy metric.
The Mentor's Analysis: COMAR dictates 80 square feet for single rooms and 60 square feet per
bed for multiple occupancy. When facing construction or remodeling, the immediate priority is
calculating usable square feet. By utilizing the 60 sq ft/bed metric, you bypass the common trap
of including closets, vestibules, and door swing areas in the calculation. Professional Intuition:
Usable space excludes service areas, door swings, and closets; calculate solely on open,
accessible flooring.
Q3: Following an unexpected utility failure, a facility loses municipal power. Based on the
principles of Emergency and Disaster Planning, what is the FIRST performance requirement the
emergency generator must meet? A) Provide a minimum of 72 hours of uninterrupted power. B)
Be tested immediately for 30 minutes under load. C) Maintain a temperature of 75°F in all
common areas of refuge. D) Come to full speed and load acceptance within 10 seconds.
● Answer: D (Come to full speed and load acceptance within 10 seconds.)
● Distractor Analysis:
○ A is incorrect: COMAR requires a 48-hour capacity from on-site fuel, not 72 hours.
○ B is incorrect: The 30-minute test is a routine monthly maintenance requirement,
not an immediate post-failure directive.
○ C is incorrect: The minimum temperature requirement for common areas of refuge
is 71°F, not 75°F.
The Mentor's Analysis: Life Safety Codes and COMAR require an immediate transition to
emergency power to support life-sustaining equipment. When facing a power outage, the
immediate priority is ensuring load acceptance within 10 seconds. By utilizing automatic transfer
switches, you bypass the common trap of relying on manual overrides during critical failures.
Professional Intuition: The 10-second load acceptance is a non-negotiable life-safety
standard designed to prevent anoxic events in ventilator-dependent residents.
Q4: An administrator is hiring a new Medical Director. Based on the principles of Medical
Director Qualifications, which candidate is the MOST APPROPRIATE choice under Maryland
law? A) A licensed physician with 1 year of clinical experience in an acute hospital. B) A
registered nurse practitioner with 5 years of geriatric care experience. C) A licensed physician
with 3 years of experience in the medical care of geriatric or chronically ill residents. D) A
licensed physician with 10 years of pediatric experience.
● Answer: C (A licensed physician with 3 years of experience in the medical care of geriatric
or chronically ill residents.)
● Distractor Analysis:
○ A is incorrect: COMAR requires at least 2 years of experience or specialized
training in geriatric or chronic care.
○ B is incorrect: The Medical Director must hold a current license as a physician in
the state, not an NP license.
○ D is incorrect: Pediatric experience does not satisfy the geriatric or chronically ill
experience mandate.
The Mentor's Analysis: The Medical Director establishes clinical policy and oversees attending
physicians. When facing executive hiring, the immediate priority is verifying the 2-year geriatric
or chronic care threshold. By utilizing specialized geriatricians, you bypass the common trap of
appointing highly experienced but contextually unsuited practitioners. Professional Intuition:
