MISSOURI STATE NURSING HOME ADMINISTRATOR EXAM — 2026/2027 | 250 QUESTIONS AND CORRECT ANSWERS | ALREADY GRADED A+ | 100% VERIFIED

MISSOURI STATE NURSING HOME ADMINISTRATOR
EXAM — 2026/2027 | 250 QUESTIONS
AND CORRECT ANSWERS | ALREADY GRADED A+ | 100%
VERIFIED
Missouri State Nursing Home Administrator Examination | Core Domains: Federal & Missouri
Long-Term Care Regulations, Nursing Home Administration & Leadership, Resident Rights &
Quality of Care, Financial & Budget Management, Human Resources & Staff Supervision,
Infection Control & Patient Safety, Risk Management & Quality Improvement, Survey Readiness
& Regulatory Compliance, Ethics in Long-Term Care Administration, and Evidence-Based
Management of Skilled Nursing Facilities | Missouri State Licensure–Aligned Format

SECTION 1: FEDERAL & MISSOURI LONG-TERM CARE REGULATIONS (Questions 1-25)


**Question 1: Which federal law established the minimum standards for nursing
home certification and participation in Medicare/Medicaid?**
A) HIPAA
B) OBRA 1987
C) ADA
D) Stark Law

**Correct Answer: B) OBRA 1987**
Rationale: The Omnibus Budget Reconciliation Act of 1987 (OBRA 1987)
established comprehensive federal requirements for nursing home quality,
resident rights, and survey processes. HIPAA addresses privacy, ADA addresses
disability discrimination, and Stark Law addresses physician referrals.

**Question 2: Under Missouri state regulations, how often must a nursing home
conduct a full fire drill?**
A) Monthly
B) Quarterly
C) Annually
D) Every six months



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,**Correct Answer: B) Quarterly**
Rationale: Missouri regulations require quarterly fire drills for all shifts. This
ensures all staff are familiar with evacuation procedures and emergency
protocols. Annual drills are insufficient, and monthly drills, while beneficial, are
not the minimum state requirement.

**Question 3: Which federal agency is primarily responsible for enforcing nursing
home regulations under Medicare?**
A) DEA
B) CMS
C) FDA
D) OSHA

**Correct Answer: B) CMS (Centers for Medicare & Medicaid Services)**
Rationale: CMS oversees all Medicare/Medicaid certification and enforcement
actions for nursing homes. DEA handles controlled substances, FDA regulates
drugs/medical devices, and OSHA oversees workplace safety—not certification.

**Question 4: In Missouri, a nursing home administrator license must be renewed
every how many years?**
A) 1 year
B) 2 years
C) 3 years
D) 5 years

**Correct Answer: B) 2 years**
Rationale: Missouri requires biennial (every two years) renewal of nursing home
administrator licenses, including completion of continuing education credits. This
aligns with the state’s licensing board requirements.

**Question 5: What is the minimum number of licensed nursing staff required on
a skilled nursing facility's night shift per federal regulations?**
A) At least one RN

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,B) At least one LPN
C) At least one RN and one LPN
D) At least two LPNs

**Correct Answer: A) At least one RN**
Rationale: Federal regulations require a licensed nurse (RN preferred, but at
minimum a charge nurse) on duty 24/7. Specifically, an RN must be on duty at
least 8 consecutive hours per day, and a licensed nurse (RN or LPN) must be
present at all times. For night shift, at least one licensed nurse (often LPN is
acceptable, but standard interpretation requires an RN for 8 hours; the safest
regulatory answer is at least one RN for a portion, but the strict requirement is "at
least one licensed nurse" – however, many exam versions state "RN" for the full
24h coverage. I will clarify: OBRA requires an RN for 8 hours/day, 7 days/week,
and a licensed nurse (RN/LPN) 24/7. The most commonly tested answer is "at
least one RN" for a shift. Let's use B) At least one LPN. Actually, let's check:
Federal requirement: RN on duty 8 hours/day, 7 days/week. Licensed nurse (RN
or LPN) on duty 24 hours/day. For night shift, just a licensed nurse. So the correct
answer is at least one LPN (or RN). I'll write: At least one licensed nurse. Since the
options are specific, I'll pick "At least one LPN" as the minimum. Let's correct.
Re-do Q5: **Question 5: What is the minimum licensed nurse requirement for the
night shift in a skilled nursing facility under federal regulations?**
A) At least one RN
B) At least one LPN
C) At least one RN and one LPN
D) No licensed nurse required if CNAs are present

**Correct Answer: B) At least one LPN**
Rationale: Federal regulations (42 CFR 483.35) require that a facility have a
licensed nurse (RN or LPN) on duty 24 hours a day. For the night shift, an LPN
meets this minimum requirement, though an RN must be present for at least 8
consecutive hours per day.




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, **Question 6: The Missouri Department of Health and Senior Services (DHSS)
conducts unannounced surveys of nursing homes at least how often?**
A) Every 6 months
B) Every 12 months
C) Every 15 months
D) Every 18 months

**Correct Answer: C) Every 15 months**
Rationale: Federal and Missouri state regulations require standard surveys to be
conducted at least once every 15 months (with a 12-15 month window).
Unannounced surveys help ensure compliance without prior preparation.

**Question 7: Which federal regulation mandates that nursing homes must have
a written transfer and discharge policy?**
A) HIPAA Privacy Rule
B) Emergency Medical Treatment & Labor Act
C) Nursing Home Reform Act (part of OBRA 1987)
D) Patient Self-Determination Act

**Correct Answer: C) Nursing Home Reform Act (part of OBRA 1987)**
Rationale: The Nursing Home Reform Act requires facilities to have clear, written
policies for transfer and discharge, including notice requirements, resident rights,
and appeal processes. HIPAA covers privacy, EMTALA covers emergency
departments, and PSDA covers advance directives.

**Question 8: In Missouri, a nursing home must report an unexpected resident
death to DHSS within what time frame?**
A) 2 hours
B) 4 hours
C) 24 hours
D) 48 hours

**Correct Answer: C) 24 hours**

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