FEDERAL NURSING HOME ADMINISTRATOR
MIDTERM EXAM — 80 Questions & Detailed Answers
Based on NAB Core of Knowledge | CMS Conditions
of Participation | OBRA '87
SECTION I: CARE, SERVICES, AND SUPPORTS
Subsection A: Resident Rights & Quality of Life (Questions 1–12)
1. The Omnibus Budget Reconciliation Act of 1987 (OBRA '87) established
which of the following fundamental requirements for nursing homes?**
- A) Medicare Part D prescription drug coverage
- B) Comprehensive nursing home reform including resident assessment and
quality of care standards
- C) Hospital reimbursement rates
- D) Physician licensing requirements
Answer: B
Rationale: OBRA '87 (the Nursing Home Reform Act) created comprehensive
nursing home reform including requirements for resident assessments (MDS),
quality of care standards, and resident rights protections. It established the
general standard of promoting "maximum practicable functioning" and
requires nursing homes to provide nursing, dietary, physician, rehabilitative,
dental, and pharmacy services.
,2. Under federal regulations (42 CFR Part 483), residents have the right to:
- A) Refuse treatment after being fully informed of the consequences
- B) Access any other resident's medical records
- C) Be restrained for staff convenience
- D) Leave the facility without notifying anyone
Answer: A
Rationale: Under 42 CFR Part 483, residents have the fundamental right to
refuse treatment after being fully informed of the risks, benefits, and
alternatives. This is a core resident right protected under federal law.
3. Which F-tag addresses resident rights and the requirement to provide
services in a manner that maintains or enhances each resident's dignity and
respect?
- A) F550
- B) F880
- C) F755
- D) F800
Answer: A
Rationale: F550 is the F-tag associated with resident rights under the State
Operations Manual Appendix PP. F880 addresses infection prevention and
control, F755 addresses pharmacy services, and F800 addresses food and
dietary services.
,4. A resident with dementia repeatedly asks to "go home." What is the most
appropriate initial response by the nursing home administrator?**
- A) Tell the resident, "You are home. This is your home now."
- B) Validate the resident's feelings and redirect to a pleasant activity
- C) Give the resident directions to the nearest exit
- D) Administer a PRN antipsychotic medication immediately
Answer: B
Rationale: Validation therapy involves acknowledging the resident's feelings
without arguing about reality. Redirecting to a pleasant activity is the most
appropriate non-pharmacologic intervention. Arguing increases agitation,
giving directions to exit is unsafe, and medications should not be the first
response under OBRA '87's mandate for non-pharmacologic interventions
first.
5. HIPAA (Health Insurance Portability and Accountability Act) primarily
protects:
- A) Facility profit margins
- B) Resident privacy and confidentiality of health information
- C) Staff wages
- D) Building safety standards
, Answer: B
Rationale: HIPAA establishes national standards to protect sensitive patient
health information from being disclosed without the patient's consent or
knowledge. Nursing home administrators must ensure facility compliance
with HIPAA privacy and security rules.
6. Which of the following is a violation of resident rights under federal
regulations?
- A) Allowing a resident to choose their own meal times
- B) Using physical restraints for staff convenience
- C) Providing privacy during medical exams
- D) Allowing residents to manage their own finances if capable
Answer: B
Rationale: Physical restraints may only be used when medically necessary,
with proper consent, and with ongoing assessment and documentation. Using
restraints for staff convenience is a violation of resident rights under 42 CFR
Part 483 and OBRA '87.
7. A physical restraint must be removed:
- A) Every hour
- B) Every 2 hours
MIDTERM EXAM — 80 Questions & Detailed Answers
Based on NAB Core of Knowledge | CMS Conditions
of Participation | OBRA '87
SECTION I: CARE, SERVICES, AND SUPPORTS
Subsection A: Resident Rights & Quality of Life (Questions 1–12)
1. The Omnibus Budget Reconciliation Act of 1987 (OBRA '87) established
which of the following fundamental requirements for nursing homes?**
- A) Medicare Part D prescription drug coverage
- B) Comprehensive nursing home reform including resident assessment and
quality of care standards
- C) Hospital reimbursement rates
- D) Physician licensing requirements
Answer: B
Rationale: OBRA '87 (the Nursing Home Reform Act) created comprehensive
nursing home reform including requirements for resident assessments (MDS),
quality of care standards, and resident rights protections. It established the
general standard of promoting "maximum practicable functioning" and
requires nursing homes to provide nursing, dietary, physician, rehabilitative,
dental, and pharmacy services.
,2. Under federal regulations (42 CFR Part 483), residents have the right to:
- A) Refuse treatment after being fully informed of the consequences
- B) Access any other resident's medical records
- C) Be restrained for staff convenience
- D) Leave the facility without notifying anyone
Answer: A
Rationale: Under 42 CFR Part 483, residents have the fundamental right to
refuse treatment after being fully informed of the risks, benefits, and
alternatives. This is a core resident right protected under federal law.
3. Which F-tag addresses resident rights and the requirement to provide
services in a manner that maintains or enhances each resident's dignity and
respect?
- A) F550
- B) F880
- C) F755
- D) F800
Answer: A
Rationale: F550 is the F-tag associated with resident rights under the State
Operations Manual Appendix PP. F880 addresses infection prevention and
control, F755 addresses pharmacy services, and F800 addresses food and
dietary services.
,4. A resident with dementia repeatedly asks to "go home." What is the most
appropriate initial response by the nursing home administrator?**
- A) Tell the resident, "You are home. This is your home now."
- B) Validate the resident's feelings and redirect to a pleasant activity
- C) Give the resident directions to the nearest exit
- D) Administer a PRN antipsychotic medication immediately
Answer: B
Rationale: Validation therapy involves acknowledging the resident's feelings
without arguing about reality. Redirecting to a pleasant activity is the most
appropriate non-pharmacologic intervention. Arguing increases agitation,
giving directions to exit is unsafe, and medications should not be the first
response under OBRA '87's mandate for non-pharmacologic interventions
first.
5. HIPAA (Health Insurance Portability and Accountability Act) primarily
protects:
- A) Facility profit margins
- B) Resident privacy and confidentiality of health information
- C) Staff wages
- D) Building safety standards
, Answer: B
Rationale: HIPAA establishes national standards to protect sensitive patient
health information from being disclosed without the patient's consent or
knowledge. Nursing home administrators must ensure facility compliance
with HIPAA privacy and security rules.
6. Which of the following is a violation of resident rights under federal
regulations?
- A) Allowing a resident to choose their own meal times
- B) Using physical restraints for staff convenience
- C) Providing privacy during medical exams
- D) Allowing residents to manage their own finances if capable
Answer: B
Rationale: Physical restraints may only be used when medically necessary,
with proper consent, and with ongoing assessment and documentation. Using
restraints for staff convenience is a violation of resident rights under 42 CFR
Part 483 and OBRA '87.
7. A physical restraint must be removed:
- A) Every hour
- B) Every 2 hours
