NAB CORE EXAM
Practice Exam Questions 2026-2027
200 Verified Questions with Comprehensive A+ Graded Rationales
Aligned with the 2026-2027 NAB Core Examination Content Outline
and the NAB Domains of Practice
Total Questions Exam Format Time Allotted
200 Multiple Choice (A-D) 150 Minutes (Actual)
,Section 1: Care, Services, and Supports (Q1 - Q50)
Q1: A nursing facility resident who is competent requests to refuse a blood transfusion based on religious beliefs. The
resident's family strongly disagrees and demands the facility proceed with the transfusion. What is the administrator's
most appropriate action?
A. Follow the family's wishes because they are the legal next of kin and have the resident's best interests at heart
B. Honor the resident's decision and document the refusal in the medical record, as competent adults have the
right to make decisions about their own care
C. Delay the decision and convene an ethics committee meeting before taking any action
D. Contact the state ombudsman to obtain a ruling before proceeding
Correct Answer: B
Rationale: Under the Nursing Home Reform Act (OBRA '87) and CMS regulations, competent residents have the absolute right to
make decisions about their own medical care, including the right to refuse treatment. This is a fundamental resident right protected by
federal law. The facility must honor the competent resident's informed decision regardless of family objections. Option A is incorrect
because family wishes do not override a competent resident's autonomous decision. Option C is unnecessary since the resident is
competent and the law is clear. Option D is inappropriate because the ombudsman does not serve as a decision-making authority for
clinical care decisions.
Q2: A resident in a long-term care facility has executed a valid Do-Not-Resuscitate (DNR) order. During a routine
care plan meeting, the resident's daughter states she was unaware of the DNR and demands it be rescinded. The
resident confirms the DNR reflects their wishes. How should the administrator respond?
A. Rescind the DNR immediately since the family member has raised a concern
B. Maintain the DNR as written because the competent resident has confirmed it reflects their wishes, and
offer to facilitate a family meeting to discuss the decision
C. Place the DNR on hold pending legal review by the facility's attorney
D. Transfer the resident to another facility to avoid potential liability
Correct Answer: B
Rationale: A DNR order is a legal advance directive that reflects the competent resident's informed wishes regarding end-of-life care.
The administrator must uphold the resident's autonomous decision while being sensitive to family concerns. Facilitating a family
meeting with the interdisciplinary team, social worker, and chaplain is the appropriate response that addresses both the resident's
rights and family dynamics. Option A violates the resident's right to self-determination. Option C introduces unnecessary legal
involvement when the resident's capacity is not in question. Option D would constitute an inappropriate transfer under OBRA '87.
Q3: The administrator is reviewing the facility's policies on resident councils. Under federal regulations, which of the
following statements about resident councils is MOST accurate?
A. The facility must establish a resident council only if a majority of residents request one in writing
B. The facility must allow residents to organize and participate in a resident council, and the council must be
given the opportunity to make recommendations to the facility regarding policies and practices
C. Resident councils are advisory only and may not address grievances or complaints about direct patient care
, D. The administrator serves as the chairperson of the resident council to ensure compliance with facility policies
Correct Answer: B
Rationale: CMS regulations (42 CFR 483.15) require facilities to support the formation and operation of resident councils. Residents
have the right to organize and participate in these councils, which serve as a collective voice for residents to make recommendations on
facility policies, services, and practices affecting their lives. The council must be listened to and responded to by facility leadership.
Option A is incorrect because the facility must support the council regardless of whether a written request is made. Option C is wrong
because councils may address any concern, including care-related grievances. Option D violates the principle of resident
self-governance.
Q4: A long-term care facility resident has been diagnosed with mild cognitive impairment but retains the capacity to
make most decisions. The resident wishes to participate in developing their care plan but has difficulty remembering
details from previous meetings. What is the BEST approach for person-centered care planning?
A. Exclude the resident from care plan meetings and rely entirely on the legal representative's input to avoid confusion
B. Provide the resident with a written summary of the previous meeting before the next one, use visual aids
during the meeting, and encourage the resident to participate in areas where they can express preferences
C. Limit care plan meetings to once per year to reduce the resident's cognitive burden
D. Make all care plan decisions based on the clinical team's assessment without resident input
Correct Answer: B
Rationale: Person-centered care planning requires maximizing resident involvement regardless of cognitive limitations. Providing
written summaries, using visual aids, and focusing on preference-based decisions are evidence-based strategies that honor the
resident's right to participate in their care planning while accommodating their cognitive impairment. OBRA '87 mandates that
residents have the right to participate in planning their care. Options A and D violate resident rights by excluding the resident from
their own care planning. Option C is insufficient and may result in outdated care plans that don't reflect current needs.
Q5: A resident's healthcare proxy presents a signed advance directive that contradicts the resident's current verbal
wishes regarding treatment. The resident states they want to change their advance directive but has not yet completed
the paperwork. What should the care team prioritize?
A. Follow the existing written advance directive until new paperwork is completed, as written documents take legal
precedence over verbal statements
B. Immediately implement the resident's current verbal wishes, as the resident's present preferences always supersede
prior written directives
C. Expedite the process of updating the advance directive to reflect the resident's current wishes and follow
the resident's verbal preferences in the interim as much as legally permissible
D. Place the matter on hold until the next quarterly care plan review
Correct Answer: C
Rationale: The resident's current expressed wishes should be honored to the greatest extent possible, while the facility works promptly
to update the legal documentation. A competent resident may revoke or change an advance directive at any time, and verbal
expression of changed intent creates an obligation to facilitate the formal update. The team should not ignore either document but
should work to align care with current wishes. Option A fails to recognize that competent residents can change their minds. Option B
overstates the immediacy without addressing the legal documentation process. Option D unnecessarily delays addressing the resident's
current wishes.
, Q6: Under CMS regulations, which of the following BEST describes the requirements for a living will in a long-term
care setting?
A. A living will must be notarized by two witnesses and filed with the state health department to be valid
B. A living will is a legal document in which a competent person specifies their wishes regarding medical
treatment in the event they become incapacitated and cannot communicate their decisions
C. A living will automatically expires after six months and must be renewed to remain in effect
D. A living will can only be created by an attorney and must be reviewed annually by a judge
Correct Answer: B
Rationale: A living will is a type of advance directive that allows a competent individual to document their treatment preferences in
advance, specifically for situations where they may lose the ability to communicate. It is a fundamental component of resident rights
under OBRA '87 and is recognized across all states, though specific witnessing requirements vary by jurisdiction. Option A describes
requirements that may apply in some states but are not universally true. Option C is false as living wills do not automatically expire.
Option D is incorrect as attorneys and judges are not required for creating a living will.
Q7: An administrator receives a complaint that a certified nursing assistant (CNA) repeatedly ignores a resident's
request to skip a shower on a particular day. The resident insists on exercising their right to choose their schedule.
What is the MOST appropriate response?
A. Support the resident's right to refuse a shower and counsel the CNA on respecting resident autonomy and
person-centered care principles
B. Reassign the resident to a different CNA without addressing the underlying issue
C. Explain to the resident that the shower schedule is set by the facility and cannot be changed
D. Document the complaint but take no further action since the CNA was following the care plan
Correct Answer: A
Rationale: Residents have the right to participate in and influence their daily schedule, including personal care activities like bathing.
The CNA's behavior violates person-centered care principles and resident rights under 42 CFR 483.10. The administrator must
address the behavior through education, and if the pattern continues, through progressive discipline. Option B fails to correct the staff
behavior. Option C violates resident rights. Option D ignores the regulatory obligation to investigate and resolve complaints.
Q8: A long-term care facility is developing its person-centered care program. Which of the following strategies
MOST effectively promotes person-centered care?
A. Implementing a rigid daily schedule that applies uniformly to all residents to ensure consistency and efficiency of
care delivery
B. Creating individualized care plans that incorporate each resident's preferences, routines, and goals, and
training staff to honor these individualized approaches
C. Focusing exclusively on clinical outcomes and quality metrics to demonstrate the facility's commitment to
high-quality care
D. Assigning each resident a primary physician who makes all care decisions without resident input
Correct Answer: B
Rationale: Person-centered care is the cornerstone of quality long-term care under CMS regulations and the NAB Domains of
Practice. It requires individualized approaches that respect each resident's unique preferences, history, routines, and goals. Staff must
be trained to elicit, document, and honor these preferences in daily care delivery. Option A describes an institutional model that
contradicts person-centered principles. Option C focuses only on clinical metrics while ignoring the psychosocial and personal
Practice Exam Questions 2026-2027
200 Verified Questions with Comprehensive A+ Graded Rationales
Aligned with the 2026-2027 NAB Core Examination Content Outline
and the NAB Domains of Practice
Total Questions Exam Format Time Allotted
200 Multiple Choice (A-D) 150 Minutes (Actual)
,Section 1: Care, Services, and Supports (Q1 - Q50)
Q1: A nursing facility resident who is competent requests to refuse a blood transfusion based on religious beliefs. The
resident's family strongly disagrees and demands the facility proceed with the transfusion. What is the administrator's
most appropriate action?
A. Follow the family's wishes because they are the legal next of kin and have the resident's best interests at heart
B. Honor the resident's decision and document the refusal in the medical record, as competent adults have the
right to make decisions about their own care
C. Delay the decision and convene an ethics committee meeting before taking any action
D. Contact the state ombudsman to obtain a ruling before proceeding
Correct Answer: B
Rationale: Under the Nursing Home Reform Act (OBRA '87) and CMS regulations, competent residents have the absolute right to
make decisions about their own medical care, including the right to refuse treatment. This is a fundamental resident right protected by
federal law. The facility must honor the competent resident's informed decision regardless of family objections. Option A is incorrect
because family wishes do not override a competent resident's autonomous decision. Option C is unnecessary since the resident is
competent and the law is clear. Option D is inappropriate because the ombudsman does not serve as a decision-making authority for
clinical care decisions.
Q2: A resident in a long-term care facility has executed a valid Do-Not-Resuscitate (DNR) order. During a routine
care plan meeting, the resident's daughter states she was unaware of the DNR and demands it be rescinded. The
resident confirms the DNR reflects their wishes. How should the administrator respond?
A. Rescind the DNR immediately since the family member has raised a concern
B. Maintain the DNR as written because the competent resident has confirmed it reflects their wishes, and
offer to facilitate a family meeting to discuss the decision
C. Place the DNR on hold pending legal review by the facility's attorney
D. Transfer the resident to another facility to avoid potential liability
Correct Answer: B
Rationale: A DNR order is a legal advance directive that reflects the competent resident's informed wishes regarding end-of-life care.
The administrator must uphold the resident's autonomous decision while being sensitive to family concerns. Facilitating a family
meeting with the interdisciplinary team, social worker, and chaplain is the appropriate response that addresses both the resident's
rights and family dynamics. Option A violates the resident's right to self-determination. Option C introduces unnecessary legal
involvement when the resident's capacity is not in question. Option D would constitute an inappropriate transfer under OBRA '87.
Q3: The administrator is reviewing the facility's policies on resident councils. Under federal regulations, which of the
following statements about resident councils is MOST accurate?
A. The facility must establish a resident council only if a majority of residents request one in writing
B. The facility must allow residents to organize and participate in a resident council, and the council must be
given the opportunity to make recommendations to the facility regarding policies and practices
C. Resident councils are advisory only and may not address grievances or complaints about direct patient care
, D. The administrator serves as the chairperson of the resident council to ensure compliance with facility policies
Correct Answer: B
Rationale: CMS regulations (42 CFR 483.15) require facilities to support the formation and operation of resident councils. Residents
have the right to organize and participate in these councils, which serve as a collective voice for residents to make recommendations on
facility policies, services, and practices affecting their lives. The council must be listened to and responded to by facility leadership.
Option A is incorrect because the facility must support the council regardless of whether a written request is made. Option C is wrong
because councils may address any concern, including care-related grievances. Option D violates the principle of resident
self-governance.
Q4: A long-term care facility resident has been diagnosed with mild cognitive impairment but retains the capacity to
make most decisions. The resident wishes to participate in developing their care plan but has difficulty remembering
details from previous meetings. What is the BEST approach for person-centered care planning?
A. Exclude the resident from care plan meetings and rely entirely on the legal representative's input to avoid confusion
B. Provide the resident with a written summary of the previous meeting before the next one, use visual aids
during the meeting, and encourage the resident to participate in areas where they can express preferences
C. Limit care plan meetings to once per year to reduce the resident's cognitive burden
D. Make all care plan decisions based on the clinical team's assessment without resident input
Correct Answer: B
Rationale: Person-centered care planning requires maximizing resident involvement regardless of cognitive limitations. Providing
written summaries, using visual aids, and focusing on preference-based decisions are evidence-based strategies that honor the
resident's right to participate in their care planning while accommodating their cognitive impairment. OBRA '87 mandates that
residents have the right to participate in planning their care. Options A and D violate resident rights by excluding the resident from
their own care planning. Option C is insufficient and may result in outdated care plans that don't reflect current needs.
Q5: A resident's healthcare proxy presents a signed advance directive that contradicts the resident's current verbal
wishes regarding treatment. The resident states they want to change their advance directive but has not yet completed
the paperwork. What should the care team prioritize?
A. Follow the existing written advance directive until new paperwork is completed, as written documents take legal
precedence over verbal statements
B. Immediately implement the resident's current verbal wishes, as the resident's present preferences always supersede
prior written directives
C. Expedite the process of updating the advance directive to reflect the resident's current wishes and follow
the resident's verbal preferences in the interim as much as legally permissible
D. Place the matter on hold until the next quarterly care plan review
Correct Answer: C
Rationale: The resident's current expressed wishes should be honored to the greatest extent possible, while the facility works promptly
to update the legal documentation. A competent resident may revoke or change an advance directive at any time, and verbal
expression of changed intent creates an obligation to facilitate the formal update. The team should not ignore either document but
should work to align care with current wishes. Option A fails to recognize that competent residents can change their minds. Option B
overstates the immediacy without addressing the legal documentation process. Option D unnecessarily delays addressing the resident's
current wishes.
, Q6: Under CMS regulations, which of the following BEST describes the requirements for a living will in a long-term
care setting?
A. A living will must be notarized by two witnesses and filed with the state health department to be valid
B. A living will is a legal document in which a competent person specifies their wishes regarding medical
treatment in the event they become incapacitated and cannot communicate their decisions
C. A living will automatically expires after six months and must be renewed to remain in effect
D. A living will can only be created by an attorney and must be reviewed annually by a judge
Correct Answer: B
Rationale: A living will is a type of advance directive that allows a competent individual to document their treatment preferences in
advance, specifically for situations where they may lose the ability to communicate. It is a fundamental component of resident rights
under OBRA '87 and is recognized across all states, though specific witnessing requirements vary by jurisdiction. Option A describes
requirements that may apply in some states but are not universally true. Option C is false as living wills do not automatically expire.
Option D is incorrect as attorneys and judges are not required for creating a living will.
Q7: An administrator receives a complaint that a certified nursing assistant (CNA) repeatedly ignores a resident's
request to skip a shower on a particular day. The resident insists on exercising their right to choose their schedule.
What is the MOST appropriate response?
A. Support the resident's right to refuse a shower and counsel the CNA on respecting resident autonomy and
person-centered care principles
B. Reassign the resident to a different CNA without addressing the underlying issue
C. Explain to the resident that the shower schedule is set by the facility and cannot be changed
D. Document the complaint but take no further action since the CNA was following the care plan
Correct Answer: A
Rationale: Residents have the right to participate in and influence their daily schedule, including personal care activities like bathing.
The CNA's behavior violates person-centered care principles and resident rights under 42 CFR 483.10. The administrator must
address the behavior through education, and if the pattern continues, through progressive discipline. Option B fails to correct the staff
behavior. Option C violates resident rights. Option D ignores the regulatory obligation to investigate and resolve complaints.
Q8: A long-term care facility is developing its person-centered care program. Which of the following strategies
MOST effectively promotes person-centered care?
A. Implementing a rigid daily schedule that applies uniformly to all residents to ensure consistency and efficiency of
care delivery
B. Creating individualized care plans that incorporate each resident's preferences, routines, and goals, and
training staff to honor these individualized approaches
C. Focusing exclusively on clinical outcomes and quality metrics to demonstrate the facility's commitment to
high-quality care
D. Assigning each resident a primary physician who makes all care decisions without resident input
Correct Answer: B
Rationale: Person-centered care is the cornerstone of quality long-term care under CMS regulations and the NAB Domains of
Practice. It requires individualized approaches that respect each resident's unique preferences, history, routines, and goals. Staff must
be trained to elicit, document, and honor these preferences in daily care delivery. Option A describes an institutional model that
contradicts person-centered principles. Option C focuses only on clinical metrics while ignoring the psychosocial and personal
