E X A M P R E PA R AT I O N G U I D E
NAB Core Exam
Study Guide
175 Comprehensive Questions and Verified
Answers aligned with the 2026-2027 NAB Core
Examination Blueprint, covering all eight
domain areas tested on the National
Association of Long Term Care Administrator
Boards certification exam.
Edition
Newest Questions and Answers
Style: Stan Mucinic Comprehensive Review
,Section 1: Care and Services
Q1: A new resident is admitted to your skilled nursing facility following a left hip replacement. The attending physician has
not yet signed the admission orders. According to CMS Requirements of Participation, what is the administrator's most
appropriate immediate action?
A. Allow the nursing staff to implement routine admission protocols without physician orders, as the facility has standing
orders for post-surgical admissions.
B. Contact the attending physician immediately to obtain verbal orders transcribed by the charge nurse, ensuring all admission
orders are documented within 24 hours per 42 CFR 483.30. **[CORRECT]**
C. Wait until the physician arrives for the initial visit within 48 hours before implementing any care, to ensure full compliance
with medical staff bylaws.
D. Transfer the resident to the nearest hospital emergency department until formal written orders can be obtained from the
attending physician.
Correct Answer: B
Rationale: Under 42 CFR 483.30, the facility must ensure that each resident receives a comprehensive assessment and that physician orders are
established and promptly transcribed. Verbal orders are permissible when immediately transcribed and countersigned within the facility's
policy timeframe. Option A is incorrect because standing orders do not substitute for individualized physician admission orders. Option C
violates the requirement for timely initiation of care. Option D is an unnecessary overreaction that could harm the resident.
Q2: Which F-Tag is specifically associated with the requirement that a facility must ensure each resident's drug regimen is
free from unnecessary drugs, and what is the key compliance requirement?
A. F-756 Unnecessary Medications requires that the facility obtain informed consent from the resident before administering
any new medication, including PRN medications.
B. F-758 Drug Regimen Review requires the consultant pharmacist to review each resident's drug regimen at least monthly and
report irregularities to the medical director and director of nursing. **[CORRECT]**
C. F-755 Pharmacy Services requires that all medications be administered by licensed nurses only, and medication aides may
not participate in the medication administration process under any circumstances.
D. F-757 Drug Administration requires that the facility maintain a 24-hour pharmacy on-site for all skilled nursing facilities to
ensure timely medication delivery.
Correct Answer: B
Rationale: F-758 addresses Drug Regimen Reviews, mandating that a licensed pharmacist conduct monthly reviews of each resident's drug
regimen and report any irregularities to the attending physician, medical director, and DON. This is a critical compliance requirement under the
Phase 3 RoP. F-756 addresses unnecessary medications but does not require consent for all new medications. F-755 covers pharmacy services
broadly but does not restrict administration to licensed nurses only. F-757 does not require a 24-hour on-site pharmacy.
Q3: Your facility's medical director has been unavailable for care plan meetings for the past three months. The Director of
Nursing reports that physician participation in care planning has declined significantly. What is the administrator's best
course of action?
A. Document the medical director's absence in the facility's quality assurance records and wait for the next medical staff
committee meeting to address the issue formally.
B. Reassign care plan physician responsibilities to the nurse practitioner on staff, as NPs can independently serve as the
attending physician for all Medicare Part A residents.
C. Schedule a meeting with the medical director to review contractual obligations under 42 CFR 483.40, discuss participation
expectations, and develop a corrective action plan including designated alternate physician coverage. **[CORRECT]**
D. Contact the state survey agency to report the medical director's non-compliance and request a survey consultation to
determine if an Immediate Jeopardy citation is warranted.
Correct Answer: C
Rationale: The medical director is responsible for coordinating medical care and participating in the facility's quality assurance process under
42 CFR 483.40. The administrator should first attempt to resolve the issue through direct communication and corrective action planning.
Option A is passive and does not address the regulatory requirement. Option B is incorrect because NPs cannot fully substitute for the medical
director's coordination role. Option D is premature; the administrator must attempt internal resolution before escalating to external agencies.
NAB Core Exam Study Guide 2026/2027 | Page 1
,Q4: A resident in your memory care unit has been losing weight progressively over the past 60 days despite nutritional
supplements. The BMI is now 17.2. The dietitian recommends a mechanical soft diet with thickened liquids. Which
regulatory requirement is most directly applicable?
A. F-688 Nutrition, which requires the facility to ensure each resident maintains acceptable parameters of nutritional status,
including body weight and hydration levels, with timely interventions when declines are identified. **[CORRECT]**
B. F-686 Food Safety, which mandates that all food served in long-term care facilities be prepared under USDA Hazard
Analysis Critical Control Point (HACCP) protocols.
C. F-689 Personalized Dining Experience, which requires facilities to offer restaurant-style dining with a minimum of three
choices at every meal.
D. F-692 Activity Programming, which mandates that facilities provide individualized cognitive stimulation programs to
maintain appetite and interest in dining among residents with dementia.
Correct Answer: A
Rationale: F-688 requires facilities to ensure residents receive adequate nutrition and hydration, maintain acceptable nutritional parameters,
and receive appropriate interventions when nutritional decline is identified. A BMI of 17.2 with progressive weight loss triggers mandatory
assessment and intervention under this tag. F-686 addresses food safety practices, not nutritional adequacy. F-689 relates to the dining
experience and choice, which is secondary to clinical nutritional decline. F-692 covers activity programming but does not address nutritional
status.
Q5: The Minimum Data Set (MDS) coordinator informs you that several Section G items (Functional Status) have been
coded inaccurately on recent assessments, which could affect RUG classification and reimbursement. What is the
administrator's primary responsibility?
A. Notify the billing department immediately to adjust the current Medicare Part A claims, and instruct the MDS coordinator
to correct the assessments prospectively only.
B. Report the inaccuracies to the QAPI committee, initiate a root cause analysis, implement corrective actions including staff
retraining on MDS coding accuracy, and submit corrected assessments as required under CMS RAI Manual guidelines.
**[CORRECT]**
C. Terminate the MDS coordinator for negligence and hire a certified MDS consultant to complete all future assessments
independently of facility staff.
D. Document the issue in an internal memo but take no further action, as MDS coding variations are common and CMS does
not audit Section G coding patterns systematically.
Correct Answer: B
Rationale: MDS accuracy directly impacts both quality measures and reimbursement. The administrator must ensure data integrity through the
QAPI program, conducting root cause analysis and implementing corrective actions. Under CMS requirements, corrected assessments must be
submitted when errors are identified. Option A addresses only the billing aspect without fixing the root cause. Option C is disproportionate.
Option D is a compliance violation, as CMS does audit MDS data and inaccurate coding can result in False Claims Act liability.
Q6: A hospice agency is providing services to three residents in your facility. The hospice nurse informs you that one
resident's family wants to discontinue hospice services and pursue curative treatment. What is the correct administrative
response?
A. Inform the family that once a resident elects the Medicare hospice benefit, the election is irrevocable for the current
certification period.
B. Support the resident's right to revoke the hospice election at any time, ensure the hospice agency is notified, coordinate
transition back to the facility's plan of care, and document the revocation. **[CORRECT]**
C. Require the family to obtain a court order before revoking hospice services.
D. Contact the state ombudsman to mediate the dispute between the family and the hospice agency.
Correct Answer: B
Rationale: Under 42 CFR 418.28, a resident may revoke the hospice election at any time and for any reason. The facility must support this
right, ensure proper notification to the hospice agency, and coordinate care transition. Option A is factually incorrect. Option C has no legal
basis. Option D is unnecessary; the ombudsman is not needed when the resident is exercising a clear statutory right.
Q7: Your facility's restorative nursing program has experienced declining participation rates over the past quarter. The
restorative nurse reports that CNAs are not consistently carrying out restorative programs due to time constraints. What
approach best addresses this?
NAB Core Exam Study Guide 2026/2027 | Page 2
, A. Eliminate the restorative nursing program and refer all residents to contracted therapy services.
B. Integrate restorative nursing activities into CNA daily assignment sheets, adjust staffing ratios to account for restorative
time, include restorative compliance in CNA performance evaluations, and monitor participation through QAPI.
**[CORRECT]**
C. Reduce the scope of the restorative program to only ambulation exercises.
D. Assign all restorative programming responsibilities exclusively to licensed nurses, as CNAs are not legally permitted to
perform restorative nursing activities.
Correct Answer: B
Rationale: Restorative nursing is a facility responsibility under 42 CFR 483.35, requiring the facility to maintain and/or improve each
resident's functional abilities. Integrating restorative activities into CNA workflows, adjusting staffing, and monitoring through QAPI is the
comprehensive approach. Option A shifts responsibility unnecessarily. Option C reduces the program scope inappropriately. Option D is
incorrect; CNAs can perform restorative activities under nurse supervision.
Q8: During a routine medication pass observation, you note that a nurse is crushing an extended-release opioid tablet to
administer through a feeding tube. What is the most critical concern and required action?
A. Document the observation and report it to the state Board of Nursing for disciplinary action.
B. Immediately intervene to stop the administration, as crushing extended-release formulations can cause rapid release of the
entire dose leading to potential fatal overdose, then review the medication process with pharmacy and nursing leadership under
F-755 and F-757. **[CORRECT]**
C. Allow the administration to proceed since the feeding tube route necessitates medication crushing.
D. Report the incident to the local police department as a potential controlled substance violation.
Correct Answer: B
Rationale: Crushing extended-release opioid formulations is a serious medication safety violation that can result in rapid drug release and
potentially fatal overdose. This is an immediate patient safety concern under F-755 and F-757. The administrator must ensure immediate
intervention, staff education, and process review. Option A overstates the issue as diversion. Option C is clinically dangerous. Option D
inappropriately escalates to law enforcement for a clinical practice issue.
Q9: The activity director proposes implementing a music therapy program for residents with advanced dementia. The
administrator should evaluate this proposal against which regulatory framework?
A. F-679 Activities, which requires the facility to provide an ongoing program of activities designed to meet the interests and
well-being of each resident, and F-685 Specialized Services for cognitive impairment. **[CORRECT]**
B. F-742 Comprehensive Person-Centered Care Planning, which requires that all activity programming be prescribed by the
attending physician.
C. The Americans with Disabilities Act (ADA), which mandates music therapy as a reasonable accommodation.
D. F-584 Facility Responsibilities for Quality Measures, which requires facilities to implement specific evidence-based
therapeutic interventions.
Correct Answer: A
Rationale: F-679 requires facilities to provide activities that address residents' interests and well-being, while F-685 addresses specialized
services for residents with dementia, including non-pharmacological interventions. Music therapy aligns with both requirements. Option B
incorrectly requires physician prescriptions for activity programs. Option C misapplies the ADA. Option D is not an actual F-Tag.
Q10: A resident's family member requests a copy of their mother's complete medical record. Under HIPAA and applicable
regulations, what is the facility's obligation?
A. Provide the records within 30 days of the request, with a reasonable cost-based fee for copying, and may withhold
psychotherapy notes if the attending physician determines disclosure would be harmful. **[CORRECT]**
B. Deny the request entirely, as family members have no legal right to access a resident's protected health information.
C. Provide only the MDS assessments and nursing notes, as physician notes are the intellectual property of the respective
practitioners.
D. Provide the records within 24 hours at no charge, as family members have an unconditional right to immediate access.
Correct Answer: A
Rationale: Under HIPAA (45 CFR 164.524), individuals have a right to access their own PHI, and authorized personal representatives may
exercise this right. The facility must provide records within 30 days and may charge a reasonable fee. Psychotherapy notes have special
protections. Option B is incorrect because authorized representatives do have access rights. Option C is wrong because physician notes are part
NAB Core Exam Study Guide 2026/2027 | Page 3
NAB Core Exam
Study Guide
175 Comprehensive Questions and Verified
Answers aligned with the 2026-2027 NAB Core
Examination Blueprint, covering all eight
domain areas tested on the National
Association of Long Term Care Administrator
Boards certification exam.
Edition
Newest Questions and Answers
Style: Stan Mucinic Comprehensive Review
,Section 1: Care and Services
Q1: A new resident is admitted to your skilled nursing facility following a left hip replacement. The attending physician has
not yet signed the admission orders. According to CMS Requirements of Participation, what is the administrator's most
appropriate immediate action?
A. Allow the nursing staff to implement routine admission protocols without physician orders, as the facility has standing
orders for post-surgical admissions.
B. Contact the attending physician immediately to obtain verbal orders transcribed by the charge nurse, ensuring all admission
orders are documented within 24 hours per 42 CFR 483.30. **[CORRECT]**
C. Wait until the physician arrives for the initial visit within 48 hours before implementing any care, to ensure full compliance
with medical staff bylaws.
D. Transfer the resident to the nearest hospital emergency department until formal written orders can be obtained from the
attending physician.
Correct Answer: B
Rationale: Under 42 CFR 483.30, the facility must ensure that each resident receives a comprehensive assessment and that physician orders are
established and promptly transcribed. Verbal orders are permissible when immediately transcribed and countersigned within the facility's
policy timeframe. Option A is incorrect because standing orders do not substitute for individualized physician admission orders. Option C
violates the requirement for timely initiation of care. Option D is an unnecessary overreaction that could harm the resident.
Q2: Which F-Tag is specifically associated with the requirement that a facility must ensure each resident's drug regimen is
free from unnecessary drugs, and what is the key compliance requirement?
A. F-756 Unnecessary Medications requires that the facility obtain informed consent from the resident before administering
any new medication, including PRN medications.
B. F-758 Drug Regimen Review requires the consultant pharmacist to review each resident's drug regimen at least monthly and
report irregularities to the medical director and director of nursing. **[CORRECT]**
C. F-755 Pharmacy Services requires that all medications be administered by licensed nurses only, and medication aides may
not participate in the medication administration process under any circumstances.
D. F-757 Drug Administration requires that the facility maintain a 24-hour pharmacy on-site for all skilled nursing facilities to
ensure timely medication delivery.
Correct Answer: B
Rationale: F-758 addresses Drug Regimen Reviews, mandating that a licensed pharmacist conduct monthly reviews of each resident's drug
regimen and report any irregularities to the attending physician, medical director, and DON. This is a critical compliance requirement under the
Phase 3 RoP. F-756 addresses unnecessary medications but does not require consent for all new medications. F-755 covers pharmacy services
broadly but does not restrict administration to licensed nurses only. F-757 does not require a 24-hour on-site pharmacy.
Q3: Your facility's medical director has been unavailable for care plan meetings for the past three months. The Director of
Nursing reports that physician participation in care planning has declined significantly. What is the administrator's best
course of action?
A. Document the medical director's absence in the facility's quality assurance records and wait for the next medical staff
committee meeting to address the issue formally.
B. Reassign care plan physician responsibilities to the nurse practitioner on staff, as NPs can independently serve as the
attending physician for all Medicare Part A residents.
C. Schedule a meeting with the medical director to review contractual obligations under 42 CFR 483.40, discuss participation
expectations, and develop a corrective action plan including designated alternate physician coverage. **[CORRECT]**
D. Contact the state survey agency to report the medical director's non-compliance and request a survey consultation to
determine if an Immediate Jeopardy citation is warranted.
Correct Answer: C
Rationale: The medical director is responsible for coordinating medical care and participating in the facility's quality assurance process under
42 CFR 483.40. The administrator should first attempt to resolve the issue through direct communication and corrective action planning.
Option A is passive and does not address the regulatory requirement. Option B is incorrect because NPs cannot fully substitute for the medical
director's coordination role. Option D is premature; the administrator must attempt internal resolution before escalating to external agencies.
NAB Core Exam Study Guide 2026/2027 | Page 1
,Q4: A resident in your memory care unit has been losing weight progressively over the past 60 days despite nutritional
supplements. The BMI is now 17.2. The dietitian recommends a mechanical soft diet with thickened liquids. Which
regulatory requirement is most directly applicable?
A. F-688 Nutrition, which requires the facility to ensure each resident maintains acceptable parameters of nutritional status,
including body weight and hydration levels, with timely interventions when declines are identified. **[CORRECT]**
B. F-686 Food Safety, which mandates that all food served in long-term care facilities be prepared under USDA Hazard
Analysis Critical Control Point (HACCP) protocols.
C. F-689 Personalized Dining Experience, which requires facilities to offer restaurant-style dining with a minimum of three
choices at every meal.
D. F-692 Activity Programming, which mandates that facilities provide individualized cognitive stimulation programs to
maintain appetite and interest in dining among residents with dementia.
Correct Answer: A
Rationale: F-688 requires facilities to ensure residents receive adequate nutrition and hydration, maintain acceptable nutritional parameters,
and receive appropriate interventions when nutritional decline is identified. A BMI of 17.2 with progressive weight loss triggers mandatory
assessment and intervention under this tag. F-686 addresses food safety practices, not nutritional adequacy. F-689 relates to the dining
experience and choice, which is secondary to clinical nutritional decline. F-692 covers activity programming but does not address nutritional
status.
Q5: The Minimum Data Set (MDS) coordinator informs you that several Section G items (Functional Status) have been
coded inaccurately on recent assessments, which could affect RUG classification and reimbursement. What is the
administrator's primary responsibility?
A. Notify the billing department immediately to adjust the current Medicare Part A claims, and instruct the MDS coordinator
to correct the assessments prospectively only.
B. Report the inaccuracies to the QAPI committee, initiate a root cause analysis, implement corrective actions including staff
retraining on MDS coding accuracy, and submit corrected assessments as required under CMS RAI Manual guidelines.
**[CORRECT]**
C. Terminate the MDS coordinator for negligence and hire a certified MDS consultant to complete all future assessments
independently of facility staff.
D. Document the issue in an internal memo but take no further action, as MDS coding variations are common and CMS does
not audit Section G coding patterns systematically.
Correct Answer: B
Rationale: MDS accuracy directly impacts both quality measures and reimbursement. The administrator must ensure data integrity through the
QAPI program, conducting root cause analysis and implementing corrective actions. Under CMS requirements, corrected assessments must be
submitted when errors are identified. Option A addresses only the billing aspect without fixing the root cause. Option C is disproportionate.
Option D is a compliance violation, as CMS does audit MDS data and inaccurate coding can result in False Claims Act liability.
Q6: A hospice agency is providing services to three residents in your facility. The hospice nurse informs you that one
resident's family wants to discontinue hospice services and pursue curative treatment. What is the correct administrative
response?
A. Inform the family that once a resident elects the Medicare hospice benefit, the election is irrevocable for the current
certification period.
B. Support the resident's right to revoke the hospice election at any time, ensure the hospice agency is notified, coordinate
transition back to the facility's plan of care, and document the revocation. **[CORRECT]**
C. Require the family to obtain a court order before revoking hospice services.
D. Contact the state ombudsman to mediate the dispute between the family and the hospice agency.
Correct Answer: B
Rationale: Under 42 CFR 418.28, a resident may revoke the hospice election at any time and for any reason. The facility must support this
right, ensure proper notification to the hospice agency, and coordinate care transition. Option A is factually incorrect. Option C has no legal
basis. Option D is unnecessary; the ombudsman is not needed when the resident is exercising a clear statutory right.
Q7: Your facility's restorative nursing program has experienced declining participation rates over the past quarter. The
restorative nurse reports that CNAs are not consistently carrying out restorative programs due to time constraints. What
approach best addresses this?
NAB Core Exam Study Guide 2026/2027 | Page 2
, A. Eliminate the restorative nursing program and refer all residents to contracted therapy services.
B. Integrate restorative nursing activities into CNA daily assignment sheets, adjust staffing ratios to account for restorative
time, include restorative compliance in CNA performance evaluations, and monitor participation through QAPI.
**[CORRECT]**
C. Reduce the scope of the restorative program to only ambulation exercises.
D. Assign all restorative programming responsibilities exclusively to licensed nurses, as CNAs are not legally permitted to
perform restorative nursing activities.
Correct Answer: B
Rationale: Restorative nursing is a facility responsibility under 42 CFR 483.35, requiring the facility to maintain and/or improve each
resident's functional abilities. Integrating restorative activities into CNA workflows, adjusting staffing, and monitoring through QAPI is the
comprehensive approach. Option A shifts responsibility unnecessarily. Option C reduces the program scope inappropriately. Option D is
incorrect; CNAs can perform restorative activities under nurse supervision.
Q8: During a routine medication pass observation, you note that a nurse is crushing an extended-release opioid tablet to
administer through a feeding tube. What is the most critical concern and required action?
A. Document the observation and report it to the state Board of Nursing for disciplinary action.
B. Immediately intervene to stop the administration, as crushing extended-release formulations can cause rapid release of the
entire dose leading to potential fatal overdose, then review the medication process with pharmacy and nursing leadership under
F-755 and F-757. **[CORRECT]**
C. Allow the administration to proceed since the feeding tube route necessitates medication crushing.
D. Report the incident to the local police department as a potential controlled substance violation.
Correct Answer: B
Rationale: Crushing extended-release opioid formulations is a serious medication safety violation that can result in rapid drug release and
potentially fatal overdose. This is an immediate patient safety concern under F-755 and F-757. The administrator must ensure immediate
intervention, staff education, and process review. Option A overstates the issue as diversion. Option C is clinically dangerous. Option D
inappropriately escalates to law enforcement for a clinical practice issue.
Q9: The activity director proposes implementing a music therapy program for residents with advanced dementia. The
administrator should evaluate this proposal against which regulatory framework?
A. F-679 Activities, which requires the facility to provide an ongoing program of activities designed to meet the interests and
well-being of each resident, and F-685 Specialized Services for cognitive impairment. **[CORRECT]**
B. F-742 Comprehensive Person-Centered Care Planning, which requires that all activity programming be prescribed by the
attending physician.
C. The Americans with Disabilities Act (ADA), which mandates music therapy as a reasonable accommodation.
D. F-584 Facility Responsibilities for Quality Measures, which requires facilities to implement specific evidence-based
therapeutic interventions.
Correct Answer: A
Rationale: F-679 requires facilities to provide activities that address residents' interests and well-being, while F-685 addresses specialized
services for residents with dementia, including non-pharmacological interventions. Music therapy aligns with both requirements. Option B
incorrectly requires physician prescriptions for activity programs. Option C misapplies the ADA. Option D is not an actual F-Tag.
Q10: A resident's family member requests a copy of their mother's complete medical record. Under HIPAA and applicable
regulations, what is the facility's obligation?
A. Provide the records within 30 days of the request, with a reasonable cost-based fee for copying, and may withhold
psychotherapy notes if the attending physician determines disclosure would be harmful. **[CORRECT]**
B. Deny the request entirely, as family members have no legal right to access a resident's protected health information.
C. Provide only the MDS assessments and nursing notes, as physician notes are the intellectual property of the respective
practitioners.
D. Provide the records within 24 hours at no charge, as family members have an unconditional right to immediate access.
Correct Answer: A
Rationale: Under HIPAA (45 CFR 164.524), individuals have a right to access their own PHI, and authorized personal representatives may
exercise this right. The facility must provide records within 30 days and may charge a reasonable fee. Psychotherapy notes have special
protections. Option B is incorrect because authorized representatives do have access rights. Option C is wrong because physician notes are part
NAB Core Exam Study Guide 2026/2027 | Page 3
