NAB RCAL Study Guide 2026/2027: Core Domains & 100+
Practice Q&A
Domain 1: Resident Care and Quality of Life
1. What is the primary focus of person-centered care in an RCAL setting?
ANSWER ✓ The primary focus is to individualize care by respecting the resident’s
preferences, values, and needs, engaging them in decision-making about their daily life
and care, and fostering a sense of autonomy and dignity within a homelike environment.
2. Name three key components of a comprehensive resident assessment
(MDS/MDS-HC).
ANSWER ✓ Three key components are: 1) Cognitive patterns and mood, 2) Physical
functioning and structural problems (ADLs, continence, skin), and 3) Preferences for
customizing routine and activities.
3. How should an RCAL manager respond to a resident’s refusal of medication?
ANSWER ✓ The manager must respect the resident's right to refuse. Staff should
document the refusal, notify the prescriber, and attempt to understand the reason for
refusal (e.g., side effects, misunderstanding) to address concerns and educate while
upholding resident autonomy.
4. What is the purpose of an individualized service plan (ISP)?
ANSWER ✓ The ISP translates assessment data into a actionable, personalized care
plan. Its purpose is to outline specific, measurable goals for the resident and detail the
staff interventions required to meet their physical, psychosocial, and functional needs.
5. Define "aging in place" in the context of assisted living.
ANSWER ✓ "Aging in place" refers to the ability of a resident to remain in the assisted
living setting even as their care needs increase, through the provision of additional
services and accommodations, rather than requiring transfer to a nursing facility.
6. What are two common signs of depression in older adults that staff should
report?
ANSWER ✓ Two common signs are: 1) Persistent sadness or withdrawal from social
activities they once enjoyed, and 2) Significant changes in sleep patterns (insomnia or
excessive sleeping) or appetite.
7. Describe a appropriate intervention for a resident with mild cognitive
impairment who is experiencing sundowning.
,ANSWER ✓ Maintain a consistent daily routine. In the late afternoon, increase calming
activities, ensure adequate lighting to reduce shadows, and minimize noise and chaos. A
gentle walk or familiar music can be soothing.
8. Why is promoting continence important, even when residents use briefs?
ANSWER ✓ Promoting continence preserves dignity, reduces risk of skin breakdown
and UTIs, and maintains higher levels of resident mobility and independence. It is a
proactive, person-centered approach versus solely a containment strategy.
9. What is the role of activities in supporting quality of life for residents with
dementia?
ANSWER ✓ Meaningful, failure-free activities reduce agitation, provide a sense of
purpose and accomplishment, stimulate preserved abilities, and offer positive ways to
connect with others, thereby enhancing overall well-being.
10. How can staff support a resident's spiritual needs?
ANSWER ✓ Staff can support spiritual needs by facilitating attendance at services,
providing private space for prayer/meditation, arranging visits from clergy, and simply
engaging in respectful conversations about the resident's beliefs and values.
Domain 2: Human Resources & Staff Management
11. What are three critical elements to include in a staff orientation program for
new RCAL aides?
ANSWER ✓ 1) Facility philosophy of person-centered care, 2) Emergency procedures
and safety protocols (fire, elopement), and 3) Hands-on training in communication
techniques and assistance with ADLs respecting dignity.
12. A long-time employee is consistently 5-10 minutes late for their shift. What is
the manager's first step?
ANSWER ✓ The manager's first step is to have a private, non-confrontational
conversation to explore the reason for the tardiness, reaffirm schedule expectations, and
collaboratively problem-solve any barriers (e.g., childcare, transportation).
13. What is "just culture" in a healthcare setting?
ANSWER ✓ "Just culture" is a system that fosters accountability without blame. It
focuses on system flaws and process errors for unintentional mistakes while maintaining
clear, consistent consequences for reckless behavior or willful violations.
, 14. Why is consistent assignment (same caregivers for same residents) beneficial?
ANSWER ✓ Consistent assignment allows staff to deeply know residents' norms,
preferences, and needs, leading to higher quality, personalized care, earlier detection of
changes in condition, and stronger, more trusting relationships.
15. Describe one effective method for providing ongoing in-service education to
staff.
ANSWER ✓ Implementing short (10-15 minute), focused "huddle" trainings on specific
topics (e.g., proper transfer technique, review of a new care plan) during shift changes is
an effective method for ongoing education.
16. What should be documented in a progressive disciplinary action?
ANSWER ✓ Document the specific performance or behavior issue, dates/times, the
counseling provided, the clear expectations for improvement, the timeline for re-
evaluation, and the potential consequences if improvement is not met.
17. How can a manager effectively delegate a task to a lead caregiver?
ANSWER ✓ Effective delegation involves: selecting the right person, clearly explaining
the task and desired outcome, granting the appropriate authority to complete it, setting
a deadline, and following up without micromanaging.
18. What is the manager's responsibility regarding mandatory reporting laws?
ANSWER ✓ The manager must ensure all staff are trained on signs of
abuse/neglect/exploitation and know the immediate procedure for internal reporting.
The manager is then legally responsible for submitting the mandatory report to the
designated state authority.
19. Name two interview questions that are illegal to ask a job applicant.
ANSWER ✓ 1) "How old are you?" or "What year did you graduate?" 2) "Are you
married?" or "Do you plan to have children?"
20. What is the primary purpose of conducting regular staff meetings?
ANSWER ✓ The primary purpose is two-way communication: to disseminate policy
updates and information from leadership, and more importantly, to solicit frontline staff
feedback, address concerns, and foster a collaborative team environment.
Domain 3: Finance & Operations
Practice Q&A
Domain 1: Resident Care and Quality of Life
1. What is the primary focus of person-centered care in an RCAL setting?
ANSWER ✓ The primary focus is to individualize care by respecting the resident’s
preferences, values, and needs, engaging them in decision-making about their daily life
and care, and fostering a sense of autonomy and dignity within a homelike environment.
2. Name three key components of a comprehensive resident assessment
(MDS/MDS-HC).
ANSWER ✓ Three key components are: 1) Cognitive patterns and mood, 2) Physical
functioning and structural problems (ADLs, continence, skin), and 3) Preferences for
customizing routine and activities.
3. How should an RCAL manager respond to a resident’s refusal of medication?
ANSWER ✓ The manager must respect the resident's right to refuse. Staff should
document the refusal, notify the prescriber, and attempt to understand the reason for
refusal (e.g., side effects, misunderstanding) to address concerns and educate while
upholding resident autonomy.
4. What is the purpose of an individualized service plan (ISP)?
ANSWER ✓ The ISP translates assessment data into a actionable, personalized care
plan. Its purpose is to outline specific, measurable goals for the resident and detail the
staff interventions required to meet their physical, psychosocial, and functional needs.
5. Define "aging in place" in the context of assisted living.
ANSWER ✓ "Aging in place" refers to the ability of a resident to remain in the assisted
living setting even as their care needs increase, through the provision of additional
services and accommodations, rather than requiring transfer to a nursing facility.
6. What are two common signs of depression in older adults that staff should
report?
ANSWER ✓ Two common signs are: 1) Persistent sadness or withdrawal from social
activities they once enjoyed, and 2) Significant changes in sleep patterns (insomnia or
excessive sleeping) or appetite.
7. Describe a appropriate intervention for a resident with mild cognitive
impairment who is experiencing sundowning.
,ANSWER ✓ Maintain a consistent daily routine. In the late afternoon, increase calming
activities, ensure adequate lighting to reduce shadows, and minimize noise and chaos. A
gentle walk or familiar music can be soothing.
8. Why is promoting continence important, even when residents use briefs?
ANSWER ✓ Promoting continence preserves dignity, reduces risk of skin breakdown
and UTIs, and maintains higher levels of resident mobility and independence. It is a
proactive, person-centered approach versus solely a containment strategy.
9. What is the role of activities in supporting quality of life for residents with
dementia?
ANSWER ✓ Meaningful, failure-free activities reduce agitation, provide a sense of
purpose and accomplishment, stimulate preserved abilities, and offer positive ways to
connect with others, thereby enhancing overall well-being.
10. How can staff support a resident's spiritual needs?
ANSWER ✓ Staff can support spiritual needs by facilitating attendance at services,
providing private space for prayer/meditation, arranging visits from clergy, and simply
engaging in respectful conversations about the resident's beliefs and values.
Domain 2: Human Resources & Staff Management
11. What are three critical elements to include in a staff orientation program for
new RCAL aides?
ANSWER ✓ 1) Facility philosophy of person-centered care, 2) Emergency procedures
and safety protocols (fire, elopement), and 3) Hands-on training in communication
techniques and assistance with ADLs respecting dignity.
12. A long-time employee is consistently 5-10 minutes late for their shift. What is
the manager's first step?
ANSWER ✓ The manager's first step is to have a private, non-confrontational
conversation to explore the reason for the tardiness, reaffirm schedule expectations, and
collaboratively problem-solve any barriers (e.g., childcare, transportation).
13. What is "just culture" in a healthcare setting?
ANSWER ✓ "Just culture" is a system that fosters accountability without blame. It
focuses on system flaws and process errors for unintentional mistakes while maintaining
clear, consistent consequences for reckless behavior or willful violations.
, 14. Why is consistent assignment (same caregivers for same residents) beneficial?
ANSWER ✓ Consistent assignment allows staff to deeply know residents' norms,
preferences, and needs, leading to higher quality, personalized care, earlier detection of
changes in condition, and stronger, more trusting relationships.
15. Describe one effective method for providing ongoing in-service education to
staff.
ANSWER ✓ Implementing short (10-15 minute), focused "huddle" trainings on specific
topics (e.g., proper transfer technique, review of a new care plan) during shift changes is
an effective method for ongoing education.
16. What should be documented in a progressive disciplinary action?
ANSWER ✓ Document the specific performance or behavior issue, dates/times, the
counseling provided, the clear expectations for improvement, the timeline for re-
evaluation, and the potential consequences if improvement is not met.
17. How can a manager effectively delegate a task to a lead caregiver?
ANSWER ✓ Effective delegation involves: selecting the right person, clearly explaining
the task and desired outcome, granting the appropriate authority to complete it, setting
a deadline, and following up without micromanaging.
18. What is the manager's responsibility regarding mandatory reporting laws?
ANSWER ✓ The manager must ensure all staff are trained on signs of
abuse/neglect/exploitation and know the immediate procedure for internal reporting.
The manager is then legally responsible for submitting the mandatory report to the
designated state authority.
19. Name two interview questions that are illegal to ask a job applicant.
ANSWER ✓ 1) "How old are you?" or "What year did you graduate?" 2) "Are you
married?" or "Do you plan to have children?"
20. What is the primary purpose of conducting regular staff meetings?
ANSWER ✓ The primary purpose is two-way communication: to disseminate policy
updates and information from leadership, and more importantly, to solicit frontline staff
feedback, address concerns, and foster a collaborative team environment.
Domain 3: Finance & Operations
