NAB NURSING HOME ADMINISTRATOR
NHA LICENSING EXAM REVIEW
Leadership, Regulatory Compliance, QAPI & Life Safety Code
150 Questions with Correct Answers and Rationales
2026/2027 Academic Year
National Association of Boards of Examiners | Licensing Examination Review
, TABLE OF CONTENTS
Section 1: Leadership & Governance (Q1–Q25) ..... 3
Section 2: Human Resources Management (Q26–Q50) ..... 16
Section 3: Finance & Business Operations (Q51–Q75) ..... 29
Section 4: Regulatory Compliance & Quality Assurance (Q76–Q100) ..... 42
Section 5: Resident Care & Clinical Management (Q101–Q125) ..... 55
Section 6: Environment & Safety (Q126–Q150) ..... 68
Note: Sections 4–6 will be included in the companion document (Part 2).
,Section 1: Leadership & Governance
This section covers organizational structure, strategic planning, board relations, ethical decision-
making, stakeholder engagement, succession planning, change management, conflict resolution,
shared governance, and mission/vision/values as defined by the NAB Core of Knowledge
Examination Blueprint.
Q1. Under the NAB Code of Ethics, which of the following actions by a nursing home
administrator most directly violates the principle of professional integrity?
A) Delegating clinical decisions to the Director of Nursing without reviewing outcomes
B) Accepting a gift of nominal value from a vendor after a competitive bidding process is
completed
C) Falsifying census data on required state reports to maintain facility licensure and
avoid corrective action
D) Disagreeing with the governing board’s decision regarding a capital expenditure
project and presenting an alternative analysis
Rationale: Falsifying data on state-required reports constitutes fraud and directly violates the
NAB Code of Ethics principle of honesty and professional integrity. CMS requires accurate
reporting under 42 CFR Part 483, and state licensure depends on truthful submissions. Delegating
clinical decisions (A) is appropriate when oversight is maintained; nominal gifts (B) after
procurement are generally permissible with disclosure; and constructive dissent (D) reflects
professional responsibility to the governing body.
Q2. When developing a strategic plan for a 120-bed skilled nursing facility, the administrator
should FIRST conduct which of the following analyses?
A) A SWOT analysis to identify internal strengths/weaknesses and external
opportunities/threats
B) A financial ratio analysis of the facility’s balance sheet and income statement
C) A market share analysis comparing the facility’s occupancy to regional competitors
D) A staffing productivity analysis to benchmark current labor costs per patient day
Rationale: A SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis is the foundational
first step in strategic planning under NAB standards because it establishes the organization’s
internal capabilities and external environment before any specific functional analysis occurs.
Financial, market, and staffing analyses (B, C, D) are important but are conducted within the
broader strategic framework established by the SWOT assessment.
, Q3. The governing board of a nonprofit nursing facility has asked the administrator to present the
facility’s quality performance data at the next board meeting. Under CMS Conditions of
Participation (42 CFR §483.70), which of the following is the governing body’s PRIMARY
responsibility?
A) Directly managing the day-to-day clinical operations of the facility
B) Ensuring the facility is operated in compliance with all federal and state
regulations
C) Hiring and terminating all frontline nursing staff without administrator involvement
D) Personally reviewing and signing off on every resident’s individualized care plan
Rationale: Under 42 CFR §483.70, the governing body is legally responsible for ensuring the
facility operates in compliance with all applicable federal and state regulations. The governing
body must appoint a licensed administrator to manage day-to-day operations (A), delegates
staffing decisions through the administrator (C), and ensures care plans are developed by qualified
interdisciplinary teams (D). Compliance oversight is the board’s non-delegable duty.
Q4. A nursing home administrator is implementing a shared governance model. Which of the
following best describes the primary purpose of shared governance in a long-term care setting?
A) To eliminate the administrator’s authority over clinical decision-making
B) To redistribute profit-sharing among all levels of staff
C) To give frontline staff and interdisciplinary teams a formal voice in policies
affecting resident care and work environment
D) To replace the governing board with a committee of department heads
Rationale: Shared governance in long-term care empowers frontline staff and interdisciplinary
teams to participate in decision-making about policies that directly affect resident care and their
work environment. It does not eliminate administrator authority (A), address compensation
structures (B), or replace the governing body (D). Research demonstrates that shared governance
improves staff retention, resident satisfaction, and quality outcomes aligned with QAPI
requirements under 42 CFR §483.75.
Q5. An administrator needs to develop a succession plan for key leadership positions. According
to NAB best practices, succession planning should include all of the following EXCEPT:
A) Identifying high-potential employees and providing them with leadership
development opportunities
B) Documenting critical competencies and knowledge required for each leadership role
NHA LICENSING EXAM REVIEW
Leadership, Regulatory Compliance, QAPI & Life Safety Code
150 Questions with Correct Answers and Rationales
2026/2027 Academic Year
National Association of Boards of Examiners | Licensing Examination Review
, TABLE OF CONTENTS
Section 1: Leadership & Governance (Q1–Q25) ..... 3
Section 2: Human Resources Management (Q26–Q50) ..... 16
Section 3: Finance & Business Operations (Q51–Q75) ..... 29
Section 4: Regulatory Compliance & Quality Assurance (Q76–Q100) ..... 42
Section 5: Resident Care & Clinical Management (Q101–Q125) ..... 55
Section 6: Environment & Safety (Q126–Q150) ..... 68
Note: Sections 4–6 will be included in the companion document (Part 2).
,Section 1: Leadership & Governance
This section covers organizational structure, strategic planning, board relations, ethical decision-
making, stakeholder engagement, succession planning, change management, conflict resolution,
shared governance, and mission/vision/values as defined by the NAB Core of Knowledge
Examination Blueprint.
Q1. Under the NAB Code of Ethics, which of the following actions by a nursing home
administrator most directly violates the principle of professional integrity?
A) Delegating clinical decisions to the Director of Nursing without reviewing outcomes
B) Accepting a gift of nominal value from a vendor after a competitive bidding process is
completed
C) Falsifying census data on required state reports to maintain facility licensure and
avoid corrective action
D) Disagreeing with the governing board’s decision regarding a capital expenditure
project and presenting an alternative analysis
Rationale: Falsifying data on state-required reports constitutes fraud and directly violates the
NAB Code of Ethics principle of honesty and professional integrity. CMS requires accurate
reporting under 42 CFR Part 483, and state licensure depends on truthful submissions. Delegating
clinical decisions (A) is appropriate when oversight is maintained; nominal gifts (B) after
procurement are generally permissible with disclosure; and constructive dissent (D) reflects
professional responsibility to the governing body.
Q2. When developing a strategic plan for a 120-bed skilled nursing facility, the administrator
should FIRST conduct which of the following analyses?
A) A SWOT analysis to identify internal strengths/weaknesses and external
opportunities/threats
B) A financial ratio analysis of the facility’s balance sheet and income statement
C) A market share analysis comparing the facility’s occupancy to regional competitors
D) A staffing productivity analysis to benchmark current labor costs per patient day
Rationale: A SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis is the foundational
first step in strategic planning under NAB standards because it establishes the organization’s
internal capabilities and external environment before any specific functional analysis occurs.
Financial, market, and staffing analyses (B, C, D) are important but are conducted within the
broader strategic framework established by the SWOT assessment.
, Q3. The governing board of a nonprofit nursing facility has asked the administrator to present the
facility’s quality performance data at the next board meeting. Under CMS Conditions of
Participation (42 CFR §483.70), which of the following is the governing body’s PRIMARY
responsibility?
A) Directly managing the day-to-day clinical operations of the facility
B) Ensuring the facility is operated in compliance with all federal and state
regulations
C) Hiring and terminating all frontline nursing staff without administrator involvement
D) Personally reviewing and signing off on every resident’s individualized care plan
Rationale: Under 42 CFR §483.70, the governing body is legally responsible for ensuring the
facility operates in compliance with all applicable federal and state regulations. The governing
body must appoint a licensed administrator to manage day-to-day operations (A), delegates
staffing decisions through the administrator (C), and ensures care plans are developed by qualified
interdisciplinary teams (D). Compliance oversight is the board’s non-delegable duty.
Q4. A nursing home administrator is implementing a shared governance model. Which of the
following best describes the primary purpose of shared governance in a long-term care setting?
A) To eliminate the administrator’s authority over clinical decision-making
B) To redistribute profit-sharing among all levels of staff
C) To give frontline staff and interdisciplinary teams a formal voice in policies
affecting resident care and work environment
D) To replace the governing board with a committee of department heads
Rationale: Shared governance in long-term care empowers frontline staff and interdisciplinary
teams to participate in decision-making about policies that directly affect resident care and their
work environment. It does not eliminate administrator authority (A), address compensation
structures (B), or replace the governing body (D). Research demonstrates that shared governance
improves staff retention, resident satisfaction, and quality outcomes aligned with QAPI
requirements under 42 CFR §483.75.
Q5. An administrator needs to develop a succession plan for key leadership positions. According
to NAB best practices, succession planning should include all of the following EXCEPT:
A) Identifying high-potential employees and providing them with leadership
development opportunities
B) Documenting critical competencies and knowledge required for each leadership role
