TEXAS NURSING HOME ADMINISTRATOR
LICENSE EXAMINATION
Comprehensive Review Examination
2026/2027 Edition | Study Set with Detailed Rationales
Total Questions: 150
Format: Multiple Choice with Rationales
Distribution: Random Topic Coverage
Cognitive Levels: Recall (30%) | Application (50%) | Analysis (20%)
Includes: Scenarios, Mini-Cases, and Data Interpretation Questions
Coverage Areas:
Texas Health and Safety Code Chapter 242 | 40 TAC Chapter 19 | HHSC Regulations | Licensing Requirements | AIT
Program | Organizational Structure | Staffing & Personnel | Staff Development | Labor Relations | Performance
Evaluation | Resident Rights | MDS 3.0 | Care Planning | Quality of Life/Care | Clinical Oversight | Nursing Services |
Medical Director Role | Pharmacy Services | Therapy Services | Dietary/Nutrition | Infection Prevention | Antibiotic
Stewardship | OSHA Standards | Safety Programs | Fire Safety | Emergency Preparedness | Environmental Services |
Life Safety Code | CMS Regulations | Medicare/Medicaid | PPS/PDPM | Financial Management | Budgeting | Risk
Management | QAPI | Incident Reporting | Abuse Prevention | Fall Prevention | Elopement Prevention | Restraint Use
| Legal Issues | Tort Liability | Compliance | Ethics | Leadership | Communication | Cultural Competency | Survey
Process
Page 1
,Q1: Under Texas Health and Safety Code Chapter 242, what is the minimum age requirement to apply
for a nursing facility administrator license in Texas?
A. 19 years of age
B. 21 years of age
C. 23 years of age
D. 25 years of age
**Correct Answer: **C****
**Rationale: Correct because Texas Health and Safety Code Section 242.401 specifically requires
applicants to be at least 23 years of age before licensure. This age requirement ensures administrators
possess sufficient maturity and life experience for the significant responsibilities of managing
long-term care facilities serving vulnerable populations.**
Q2: The Texas Health and Human Services Commission (HHSC) is responsible for which primary
function regarding nursing facilities?
A. Setting Medicare reimbursement rates nationally
B. Licensing, regulating, and surveying nursing facilities in Texas
C. Administering state employee pension programs
D. Conducting criminal prosecutions for facility abuse
**Correct Answer: **C****
**Rationale: Correct because HHSC serves as the state agency responsible for licensing, certifying,
regulating, and surveying all nursing facilities operating within Texas borders. HHSC ensures
compliance with both federal CMS requirements and Texas-specific regulations through its Regulatory
Services Division.**
Q3: According to 40 TAC Section 19.100, what must be included in a nursing facility's written
admission agreement?
A. Resident's complete medical history dating back 10 years
B. Guarantee of specific room assignments for duration of stay
C. Items and services included in the basic daily rate and those requiring additional
payment
D. Waiver of resident rights upon signature
**Correct Answer: **C****
**Rationale: Correct because federal and Texas regulations require admission agreements to clearly
disclose what services are covered in the base rate versus those billed separately. This transparency
requirement protects residents from unexpected charges and enables informed financial planning for
long-term care.**
Q4: What constitutes the maximum time period a Texas nursing facility administrator has to report a
suspected case of abuse or neglect to HHSC?
A. Immediately but no later than 24 hours after suspicion arises
B. 48 hours from the time of discovery
C. Immediately but no later than 24 hours after forming a reasonable suspicion
D. 72 hours for verbal reports with 7 days for written documentation
**Correct Answer: **C****
**Rationale: Correct because Texas law mandates immediate reporting of suspected abuse or neglect,
with an absolute deadline of 24 hours. This rapid reporting requirement enables timely investigation
and intervention to protect vulnerable residents from ongoing harm or further victimization.**
Page 2
,Q5: The Graduate Administrator-in-Training (AIT) program in Texas requires how many minimum
hours of supervised administrative experience?
A. 1,000 hours over 6 months
B. 1,500 hours over 9 months
C. 2,000 hours over 12 months
D. 2,400 hours over 18 months
**Correct Answer: **C****
**Rationale: Correct because the Texas AIT program requires completion of 2,000 hours of supervised
training under a licensed preceptor within a 12-month period. This intensive practicum ensures
candidates develop competency across all operational domains before assuming independent
administrative responsibility.**
Q6: In the organizational structure of a typical Texas skilled nursing facility, to whom does the
Director of Nursing (DON) directly report?
A. The Medical Director
B. The Board of Directors
C. The Administrator
D. The Regional Corporate Office
**Correct Answer: **C****
**Rationale: Correct because the DON maintains a direct reporting relationship to the Administrator in
standard SNF organizational hierarchy. This structure ensures unified clinical leadership while
maintaining clear accountability chains for all patient care operations and nursing department
functions.**
Q7: Which document serves as the foundational governance instrument establishing authority
relationships within a Texas nursing facility?
A. Employee Handbook
B. Policy and Procedure Manual
C. Organizational Chart and Job Descriptions
D. Marketing Plan
**Correct Answer: **C****
**Rationale: Correct because the organizational chart combined with formal job descriptions
establishes the official chain of command, reporting relationships, and scope of authority for each
position. This documentation forms the structural foundation for accountability and operational clarity
throughout the facility.**
Q8: When implementing organizational change in a Texas nursing facility, what leadership approach
demonstrates highest effectiveness according to healthcare management research?
A. Autocratic directive without staff input
B. Laissez-faire allowing departments to self-manage transition
C. Participatory change management involving key stakeholders
D. Incremental change implemented without announcement
**Correct Answer: **C****
**Rationale: Correct because participatory change management consistently yields superior outcomes
in healthcare settings by building staff buy-in, identifying implementation barriers early, and
leveraging frontline expertise. Research demonstrates this approach reduces resistance and accelerates
adoption of new processes.**
Page 3
, Q9: The governing body of a Texas nursing facility bears ultimate legal responsibility for which
aspect of operations?
A. Daily dietary menu planning
B. Scheduling nursing assistant shifts
C. Quality of care, fiscal solvency, and regulatory compliance
D. Housekeeping supply inventory levels
**Correct Answer: **C****
**Rationale: Correct because the governing body (whether owner, board, or corporate entity) maintains
fiduciary and legal responsibility for ensuring the facility delivers quality care, remains financially
viable, and complies with all applicable regulations. This responsibility cannot be delegated to the
Administrator.**
Q10: What is the recommended span of control for a nursing home administrator supervising
department heads?
A. 3-5 direct reports maximum
B. 15-20 direct reports across all departments
C. 5-9 direct reports representing major functional areas
D. Unlimited as long as job descriptions exist
**Correct Answer: **C****
**Rationale: Correct because management research indicates optimal spans of control range from 5-9
direct reports for effective supervision. This range allows adequate attention to each department head's
needs while maintaining manageable oversight complexity for the Administrator role.**
Q11: Under federal nursing facility requirements, what staffing data must be submitted quarterly to
CMS through the Payroll-Based Journal (PBJ) system?
A. Only registered nurse hours worked
B. Volunteer hours and contracted service time
C. All hours worked by nursing staff including contractors and volunteers
D. Administrative and housekeeping staff hours only
**Correct Answer: **C****
**Rationale: Correct because PBJ requires submission of all nursing staff hours including employees,
contractors, and volunteers who provide direct care. This comprehensive data collection enables CMS
to assess staffing levels accurately and correlate them with quality outcomes across facilities
nationwide.**
Q12: A Texas nursing facility experiences 35% annual turnover among certified nursing assistants.
Which retention strategy should the Administrator prioritize first?
A. Increase starting wages by 10% across the board
B. Implement mandatory overtime scheduling to cover vacancies
C. Conduct exit interviews and stay interviews to identify root causes
D. Reduce orientation period from 2 weeks to 3 days
**Correct Answer: **C****
**Rationale: Correct because evidence-based retention begins with understanding why employees leave
and why current employees stay. Exit and stay interviews reveal actionable insights about workplace
culture, compensation competitiveness, management practices, and professional development
opportunities driving turnover decisions.**
Page 4
LICENSE EXAMINATION
Comprehensive Review Examination
2026/2027 Edition | Study Set with Detailed Rationales
Total Questions: 150
Format: Multiple Choice with Rationales
Distribution: Random Topic Coverage
Cognitive Levels: Recall (30%) | Application (50%) | Analysis (20%)
Includes: Scenarios, Mini-Cases, and Data Interpretation Questions
Coverage Areas:
Texas Health and Safety Code Chapter 242 | 40 TAC Chapter 19 | HHSC Regulations | Licensing Requirements | AIT
Program | Organizational Structure | Staffing & Personnel | Staff Development | Labor Relations | Performance
Evaluation | Resident Rights | MDS 3.0 | Care Planning | Quality of Life/Care | Clinical Oversight | Nursing Services |
Medical Director Role | Pharmacy Services | Therapy Services | Dietary/Nutrition | Infection Prevention | Antibiotic
Stewardship | OSHA Standards | Safety Programs | Fire Safety | Emergency Preparedness | Environmental Services |
Life Safety Code | CMS Regulations | Medicare/Medicaid | PPS/PDPM | Financial Management | Budgeting | Risk
Management | QAPI | Incident Reporting | Abuse Prevention | Fall Prevention | Elopement Prevention | Restraint Use
| Legal Issues | Tort Liability | Compliance | Ethics | Leadership | Communication | Cultural Competency | Survey
Process
Page 1
,Q1: Under Texas Health and Safety Code Chapter 242, what is the minimum age requirement to apply
for a nursing facility administrator license in Texas?
A. 19 years of age
B. 21 years of age
C. 23 years of age
D. 25 years of age
**Correct Answer: **C****
**Rationale: Correct because Texas Health and Safety Code Section 242.401 specifically requires
applicants to be at least 23 years of age before licensure. This age requirement ensures administrators
possess sufficient maturity and life experience for the significant responsibilities of managing
long-term care facilities serving vulnerable populations.**
Q2: The Texas Health and Human Services Commission (HHSC) is responsible for which primary
function regarding nursing facilities?
A. Setting Medicare reimbursement rates nationally
B. Licensing, regulating, and surveying nursing facilities in Texas
C. Administering state employee pension programs
D. Conducting criminal prosecutions for facility abuse
**Correct Answer: **C****
**Rationale: Correct because HHSC serves as the state agency responsible for licensing, certifying,
regulating, and surveying all nursing facilities operating within Texas borders. HHSC ensures
compliance with both federal CMS requirements and Texas-specific regulations through its Regulatory
Services Division.**
Q3: According to 40 TAC Section 19.100, what must be included in a nursing facility's written
admission agreement?
A. Resident's complete medical history dating back 10 years
B. Guarantee of specific room assignments for duration of stay
C. Items and services included in the basic daily rate and those requiring additional
payment
D. Waiver of resident rights upon signature
**Correct Answer: **C****
**Rationale: Correct because federal and Texas regulations require admission agreements to clearly
disclose what services are covered in the base rate versus those billed separately. This transparency
requirement protects residents from unexpected charges and enables informed financial planning for
long-term care.**
Q4: What constitutes the maximum time period a Texas nursing facility administrator has to report a
suspected case of abuse or neglect to HHSC?
A. Immediately but no later than 24 hours after suspicion arises
B. 48 hours from the time of discovery
C. Immediately but no later than 24 hours after forming a reasonable suspicion
D. 72 hours for verbal reports with 7 days for written documentation
**Correct Answer: **C****
**Rationale: Correct because Texas law mandates immediate reporting of suspected abuse or neglect,
with an absolute deadline of 24 hours. This rapid reporting requirement enables timely investigation
and intervention to protect vulnerable residents from ongoing harm or further victimization.**
Page 2
,Q5: The Graduate Administrator-in-Training (AIT) program in Texas requires how many minimum
hours of supervised administrative experience?
A. 1,000 hours over 6 months
B. 1,500 hours over 9 months
C. 2,000 hours over 12 months
D. 2,400 hours over 18 months
**Correct Answer: **C****
**Rationale: Correct because the Texas AIT program requires completion of 2,000 hours of supervised
training under a licensed preceptor within a 12-month period. This intensive practicum ensures
candidates develop competency across all operational domains before assuming independent
administrative responsibility.**
Q6: In the organizational structure of a typical Texas skilled nursing facility, to whom does the
Director of Nursing (DON) directly report?
A. The Medical Director
B. The Board of Directors
C. The Administrator
D. The Regional Corporate Office
**Correct Answer: **C****
**Rationale: Correct because the DON maintains a direct reporting relationship to the Administrator in
standard SNF organizational hierarchy. This structure ensures unified clinical leadership while
maintaining clear accountability chains for all patient care operations and nursing department
functions.**
Q7: Which document serves as the foundational governance instrument establishing authority
relationships within a Texas nursing facility?
A. Employee Handbook
B. Policy and Procedure Manual
C. Organizational Chart and Job Descriptions
D. Marketing Plan
**Correct Answer: **C****
**Rationale: Correct because the organizational chart combined with formal job descriptions
establishes the official chain of command, reporting relationships, and scope of authority for each
position. This documentation forms the structural foundation for accountability and operational clarity
throughout the facility.**
Q8: When implementing organizational change in a Texas nursing facility, what leadership approach
demonstrates highest effectiveness according to healthcare management research?
A. Autocratic directive without staff input
B. Laissez-faire allowing departments to self-manage transition
C. Participatory change management involving key stakeholders
D. Incremental change implemented without announcement
**Correct Answer: **C****
**Rationale: Correct because participatory change management consistently yields superior outcomes
in healthcare settings by building staff buy-in, identifying implementation barriers early, and
leveraging frontline expertise. Research demonstrates this approach reduces resistance and accelerates
adoption of new processes.**
Page 3
, Q9: The governing body of a Texas nursing facility bears ultimate legal responsibility for which
aspect of operations?
A. Daily dietary menu planning
B. Scheduling nursing assistant shifts
C. Quality of care, fiscal solvency, and regulatory compliance
D. Housekeeping supply inventory levels
**Correct Answer: **C****
**Rationale: Correct because the governing body (whether owner, board, or corporate entity) maintains
fiduciary and legal responsibility for ensuring the facility delivers quality care, remains financially
viable, and complies with all applicable regulations. This responsibility cannot be delegated to the
Administrator.**
Q10: What is the recommended span of control for a nursing home administrator supervising
department heads?
A. 3-5 direct reports maximum
B. 15-20 direct reports across all departments
C. 5-9 direct reports representing major functional areas
D. Unlimited as long as job descriptions exist
**Correct Answer: **C****
**Rationale: Correct because management research indicates optimal spans of control range from 5-9
direct reports for effective supervision. This range allows adequate attention to each department head's
needs while maintaining manageable oversight complexity for the Administrator role.**
Q11: Under federal nursing facility requirements, what staffing data must be submitted quarterly to
CMS through the Payroll-Based Journal (PBJ) system?
A. Only registered nurse hours worked
B. Volunteer hours and contracted service time
C. All hours worked by nursing staff including contractors and volunteers
D. Administrative and housekeeping staff hours only
**Correct Answer: **C****
**Rationale: Correct because PBJ requires submission of all nursing staff hours including employees,
contractors, and volunteers who provide direct care. This comprehensive data collection enables CMS
to assess staffing levels accurately and correlate them with quality outcomes across facilities
nationwide.**
Q12: A Texas nursing facility experiences 35% annual turnover among certified nursing assistants.
Which retention strategy should the Administrator prioritize first?
A. Increase starting wages by 10% across the board
B. Implement mandatory overtime scheduling to cover vacancies
C. Conduct exit interviews and stay interviews to identify root causes
D. Reduce orientation period from 2 weeks to 3 days
**Correct Answer: **C****
**Rationale: Correct because evidence-based retention begins with understanding why employees leave
and why current employees stay. Exit and stay interviews reveal actionable insights about workplace
culture, compensation competitiveness, management practices, and professional development
opportunities driving turnover decisions.**
Page 4
