Page 1 of 132
FEDERAL NURSING HOME
ADMINISTRATOR (NHA) EXAM GUIDE
## 2026-2027 PRACTICE QUESTION BANK
itsjereguides
## DOMAIN 1: CARE, SERVICES, AND SUPPORTS
### Resident Rights and Autonomy
**Question 1**
An 85-year-old resident with mild cognitive impairment insists on walking to the dining room
independently, despite a recent fall that resulted in a minor injury. The nursing staff is concerned
about safety and wants to implement a bed alarm and require staff assistance for all transfers.
The resident's family supports the staff's recommendation. The nursing home administrator's
most appropriate initial action is to:
A. Implement the bed alarm and transfer assistance immediately to ensure resident safety and
reduce liability
B. Schedule a care conference with the resident, family, and interdisciplinary team to discuss
concerns while respecting the resident's autonomy
C. Document the family's consent and implement the safety measures without involving the
resident further
D. Restrict the resident to her room except for scheduled activities until a full assessment is
completed
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**Correct Answer: B**
**Rationale:** The correct answer is B because the nursing home administrator must balance
resident safety with the fundamental right to autonomy and self-determination. The Omnibus
Budget Reconciliation Act (OBRA) of 1987 establishes that residents have the right to make
choices about their daily routines and care, even when those choices carry some risk . A care
conference involving the resident, family, and interdisciplinary team demonstrates respect for the
resident's autonomy while collaboratively addressing safety concerns. This approach aligns with
person-centered care principles and meets regulatory requirements for resident involvement in
care planning.
**Why the other options are wrong:**
- **Option A**: Implementing measures without resident input violates the resident's rights
under OBRA and disregards the requirement for informed consent and participation in care
decisions.
- **Option C**: Obtaining family consent without including the resident is insufficient. While
family input is valuable, the resident's wishes must be central to care decisions, especially when
the resident can participate in the discussion.
- **Option D**: Restricting the resident's movement constitutes a restraint, which requires
thorough assessment, documentation of necessity, and consideration of less restrictive
alternatives. This action would be a violation of resident rights without proper process.
---
**Question 2**
A nursing home receives a complaint from a resident's family member that the resident has been
receiving psychotropic medications without informed consent. The medical record shows the
resident signed a consent form upon admission. However, the resident has a diagnosis of
moderate dementia. Which of the following statements is most accurate regarding the validity of
this consent?
,Page 3 of 132
A. The consent is valid because it was signed upon admission and is legally binding
B. The consent may be invalid if the resident lacked the capacity to understand the treatment at
the time of consent
C. The consent is valid only if the resident's physician prescribed the medication and
documented the indication
D. The consent must be re-obtained from the resident's legal representative every 30 days
**Correct Answer: B**
**Rationale:** Informed consent requires that the individual giving consent has the capacity to
understand the nature, risks, and benefits of the proposed treatment . A resident with dementia
may or may not have capacity at the time of consent. If the resident lacked capacity at admission,
the consent would be invalid. The facility must assess capacity and obtain consent from the
resident's legal representative when appropriate. This is a critical OBRA requirement protecting
residents from unnecessary or unwanted chemical restraints.
**Why the other options are wrong:**
- **Option A**: Consent signed upon admission is not automatically valid if the resident lacked
capacity at the time of signing. Capacity is specific to the decision being made and must be
assessed at the time of decision-making.
- **Option C**: While physician prescription and indication are important, they do not replace
the requirement for valid informed consent from the resident or their representative.
- **Option D**: There is no specific federal requirement for re-obtaining consent every 30 days.
Consent must be reviewed periodically, but the timeframe depends on the treatment and changes
in the resident's condition.
---
**Question 3**
, Page 4 of 132
A resident with advanced Alzheimer's disease exhibits wandering behavior and has attempted to
leave the facility on several occasions. The facility's immediate goal is to prevent elopement
while maximizing the resident's quality of life. Which approach best aligns with federal
regulations and person-centered care principles?
A. Install a locked door with a keypad at the exit and keep the code confidential from the
resident
B. Place the resident in a secured dementia unit with monitored access and engage the resident in
meaningful activities
C. Apply a wrist alarm that alerts staff when the resident approaches an exit
D. Increase the resident's psychotropic medication to reduce agitation and wandering
**Correct Answer: B**
**Rationale:** A secured dementia unit with monitored access is a permissible approach that
balances safety with quality of life when less restrictive measures have been attempted. This
solution meets the OBRA requirement that restraints are used only to ensure the physical safety
of the resident or other residents and only upon written order of a physician, with regular
assessment for reduction . Additionally, engaging the resident in meaningful activities addresses
the underlying need that may be causing the wandering, consistent with person-centered care.
**Why the other options are wrong:**
- **Option A**: A locked door without appropriate monitoring may be considered a restraint and
does not address the underlying need for engagement. It may also create a fire safety hazard if
not properly designed with emergency egress.
- **Option C**: A wrist alarm is a restraint that restricts the resident's freedom of movement and
should only be used as a last resort, not as an immediate solution. It also does not address the
underlying need.
- **Option D**: Using psychotropic medication to manage behavior without a specific
psychiatric indication violates OBRA's chemical restraint requirements. Medications must be
prescribed for a specific condition and used only when necessary, with gradual dose reduction
attempts.
FEDERAL NURSING HOME
ADMINISTRATOR (NHA) EXAM GUIDE
## 2026-2027 PRACTICE QUESTION BANK
itsjereguides
## DOMAIN 1: CARE, SERVICES, AND SUPPORTS
### Resident Rights and Autonomy
**Question 1**
An 85-year-old resident with mild cognitive impairment insists on walking to the dining room
independently, despite a recent fall that resulted in a minor injury. The nursing staff is concerned
about safety and wants to implement a bed alarm and require staff assistance for all transfers.
The resident's family supports the staff's recommendation. The nursing home administrator's
most appropriate initial action is to:
A. Implement the bed alarm and transfer assistance immediately to ensure resident safety and
reduce liability
B. Schedule a care conference with the resident, family, and interdisciplinary team to discuss
concerns while respecting the resident's autonomy
C. Document the family's consent and implement the safety measures without involving the
resident further
D. Restrict the resident to her room except for scheduled activities until a full assessment is
completed
,Page 2 of 132
**Correct Answer: B**
**Rationale:** The correct answer is B because the nursing home administrator must balance
resident safety with the fundamental right to autonomy and self-determination. The Omnibus
Budget Reconciliation Act (OBRA) of 1987 establishes that residents have the right to make
choices about their daily routines and care, even when those choices carry some risk . A care
conference involving the resident, family, and interdisciplinary team demonstrates respect for the
resident's autonomy while collaboratively addressing safety concerns. This approach aligns with
person-centered care principles and meets regulatory requirements for resident involvement in
care planning.
**Why the other options are wrong:**
- **Option A**: Implementing measures without resident input violates the resident's rights
under OBRA and disregards the requirement for informed consent and participation in care
decisions.
- **Option C**: Obtaining family consent without including the resident is insufficient. While
family input is valuable, the resident's wishes must be central to care decisions, especially when
the resident can participate in the discussion.
- **Option D**: Restricting the resident's movement constitutes a restraint, which requires
thorough assessment, documentation of necessity, and consideration of less restrictive
alternatives. This action would be a violation of resident rights without proper process.
---
**Question 2**
A nursing home receives a complaint from a resident's family member that the resident has been
receiving psychotropic medications without informed consent. The medical record shows the
resident signed a consent form upon admission. However, the resident has a diagnosis of
moderate dementia. Which of the following statements is most accurate regarding the validity of
this consent?
,Page 3 of 132
A. The consent is valid because it was signed upon admission and is legally binding
B. The consent may be invalid if the resident lacked the capacity to understand the treatment at
the time of consent
C. The consent is valid only if the resident's physician prescribed the medication and
documented the indication
D. The consent must be re-obtained from the resident's legal representative every 30 days
**Correct Answer: B**
**Rationale:** Informed consent requires that the individual giving consent has the capacity to
understand the nature, risks, and benefits of the proposed treatment . A resident with dementia
may or may not have capacity at the time of consent. If the resident lacked capacity at admission,
the consent would be invalid. The facility must assess capacity and obtain consent from the
resident's legal representative when appropriate. This is a critical OBRA requirement protecting
residents from unnecessary or unwanted chemical restraints.
**Why the other options are wrong:**
- **Option A**: Consent signed upon admission is not automatically valid if the resident lacked
capacity at the time of signing. Capacity is specific to the decision being made and must be
assessed at the time of decision-making.
- **Option C**: While physician prescription and indication are important, they do not replace
the requirement for valid informed consent from the resident or their representative.
- **Option D**: There is no specific federal requirement for re-obtaining consent every 30 days.
Consent must be reviewed periodically, but the timeframe depends on the treatment and changes
in the resident's condition.
---
**Question 3**
, Page 4 of 132
A resident with advanced Alzheimer's disease exhibits wandering behavior and has attempted to
leave the facility on several occasions. The facility's immediate goal is to prevent elopement
while maximizing the resident's quality of life. Which approach best aligns with federal
regulations and person-centered care principles?
A. Install a locked door with a keypad at the exit and keep the code confidential from the
resident
B. Place the resident in a secured dementia unit with monitored access and engage the resident in
meaningful activities
C. Apply a wrist alarm that alerts staff when the resident approaches an exit
D. Increase the resident's psychotropic medication to reduce agitation and wandering
**Correct Answer: B**
**Rationale:** A secured dementia unit with monitored access is a permissible approach that
balances safety with quality of life when less restrictive measures have been attempted. This
solution meets the OBRA requirement that restraints are used only to ensure the physical safety
of the resident or other residents and only upon written order of a physician, with regular
assessment for reduction . Additionally, engaging the resident in meaningful activities addresses
the underlying need that may be causing the wandering, consistent with person-centered care.
**Why the other options are wrong:**
- **Option A**: A locked door without appropriate monitoring may be considered a restraint and
does not address the underlying need for engagement. It may also create a fire safety hazard if
not properly designed with emergency egress.
- **Option C**: A wrist alarm is a restraint that restricts the resident's freedom of movement and
should only be used as a last resort, not as an immediate solution. It also does not address the
underlying need.
- **Option D**: Using psychotropic medication to manage behavior without a specific
psychiatric indication violates OBRA's chemical restraint requirements. Medications must be
prescribed for a specific condition and used only when necessary, with gradual dose reduction
attempts.
