1|Page
NAB CORE EXAM PRACTICE
QUESTIONS, ANSWERS, AND DETAILED
RATIONALES — LATEST STUDY
EDITION
INTRODUCTION
The NAB Core of Knowledge Examination (CORE) is a national examination designed to assess
foundational knowledge applicable across long-term-care administration. NAB describes the
CORE examination as a mandatory component for aspiring administrators and reports it
separately from the line-of-service examinations. The current examination framework is based
on the Domains of Practice established following NAB's Professional Practice Analysis.
For examinations through June 30, 2027, the CORE framework uses four broad domains: Care,
Services, and Supports; Operations; Environment and Quality; and Leadership and
Strategy. NAB has completed a 2026 Professional Practice Analysis that reorganizes the
framework into nine stand-alone domains for examinations beginning July 1, 2027.
This practice bank uses challenging, original, scenario-based questions designed to develop
application, analysis, prioritization, and administrative decision-making skills. Questions
integrate concepts such as person-centered care, finance, human resources, risk management,
quality improvement, regulatory compliance, communication, governance, and strategic
leadership. NAB recommends using multiple references rather than relying on a single study
source.
CONTENT AREA OVERVIEW
| CONTENT AREA | QUESTIONS | KEY TOPICS | SUGGESTED STUDY WEIGHT |
| 1. Care, Services, and Supports | Q1–25 | Person-centered care, resident rights, care
planning, quality of life, interdisciplinary coordination, behavioral health, services and
supports | 25% |
| 2. Operations | Q26–55 | Finance, budgeting, reimbursement, human resources, staffing,
communication, information systems, purchasing, organizational operations | 30% |
| 3. Environment and Quality | Q56–80 | Safety, emergency preparedness, infection
prevention, physical environment, quality improvement, risk management, regulatory
readiness | 25% |
,2|Page
| 4. Leadership and Strategy | Q81–100 | Governance, leadership, ethics, strategic planning,
change management, organizational culture, stakeholder relations, performance
management | 20% |
NOTE: The percentages above are study-allocation weights for this practice bank, not claims
about official NAB item percentages. NAB's currently effective framework through June 30,
2027 consists of the four domains listed above.
QUESTIONS 1–100
DOMAIN 1 — CARE, SERVICES, AND SUPPORTS
Q1:
A long-term-care facility receives repeated complaints that residents with significant cognitive
impairment are being awakened at 5:00 a.m. so staff can complete morning care efficiently. The
director of nursing argues that changing the schedule would disrupt staffing efficiency. Which
administrative action BEST reflects person-centered care?
A) Require all residents to follow the facility's standard morning schedule
B) Establish individualized routines while evaluating staffing and workflow implications
C) Allow residents to refuse all morning care without further intervention
D) Move all residents with cognitive impairment to a separate unit
Rationale: The correct answer is B because person-centered care requires adapting services to
individual preferences and needs while maintaining safe operations. Option A prioritizes
institutional convenience over individual choice. Option C is too absolute because the facility
still has responsibilities for assessment, communication, and safe care planning. Option D
unnecessarily segregates residents and does not address the underlying preference issue.
Q2:
A resident's family requests that staff provide a highly restrictive diet despite the resident
repeatedly expressing a preference for a different diet. The resident has decision-making capacity
and understands the potential consequences. What should the administrator prioritize?
A) The family's request because relatives are responsible for the resident
B) The physician's preference regardless of resident wishes
C) The capable resident's informed preferences while coordinating an appropriate care
plan
D) The facility's standard dietary protocol
,3|Page
Rationale: The correct answer is C because a resident with decision-making capacity generally
has the right to participate in decisions concerning personal care and preferences. Option A
improperly substitutes family preference for the resident's expressed wishes. Option B overstates
the authority of a clinician when the issue involves a capable resident's informed choice. Option
D fails to individualize care.
Q3:
During a care conference, nursing staff report that a resident's repeated nighttime wandering has
increased. The family requests immediate physical restraints. What is the BEST initial
administrative response?
A) Approve restraints because wandering creates liability
B) Transfer the resident to another facility
C) Ensure the interdisciplinary team assesses causes and develops the least restrictive
appropriate interventions
D) Discontinue nighttime monitoring to preserve resident independence
Rationale: The correct answer is C because behavioral changes require assessment and
individualized interventions. Potential contributors may include pain, medication effects,
environmental triggers, sleep disruption, or unmet needs. Option A jumps directly to a restrictive
intervention. Option B avoids the underlying problem. Option D could increase risk rather than
address it.
Q4:
A resident with advanced dementia begins refusing bathing. Staff members believe the refusal is
simply "noncompliance." Which approach is most appropriate?
A) Increase staff pressure until the resident cooperates
B) Schedule disciplinary consequences
C) Assess possible causes of refusal and modify the approach to the resident's needs
D) Permanently discontinue bathing assistance
Rationale: The correct answer is C because refusal can communicate discomfort, fear, pain,
embarrassment, trauma, or another unmet need. Individualized assessment and modification of
the care approach are more appropriate than coercion. Option A can escalate distress. Option B
is inappropriate because care refusal is not a disciplinary issue. Option D abandons necessary
hygiene support.
Q5:
A facility's resident satisfaction survey shows that residents rate meals highly for quality but
poorly for choice. Which intervention would BEST address the finding?
, 4|Page
A) Replace the dietary manager
B) Reduce the number of available menu items
C) Engage residents in menu planning and evaluate preferences against nutritional
requirements
D) Require residents to select meals one month in advance
Rationale: The correct answer is C because resident involvement directly addresses choice while
preserving nutritional and safety requirements. Option A is premature because the data identify
a service issue rather than individual managerial failure. Option B would reduce choice further.
Option D may not accommodate changing preferences or circumstances.
Q6:
A resident's care plan contains several interventions, but direct-care staff cannot explain why one
intervention is being used. What should the administrator do FIRST?
A) Remove the intervention from the care plan
B) Discipline the staff involved
C) Determine whether the care plan is clear, current, and communicated effectively to the
interdisciplinary team
D) Rewrite every resident's care plan
Rationale: The correct answer is C because effective care depends on a current, understandable
plan that is communicated to those responsible for implementation. Option A could eliminate a
necessary intervention without assessment. Option B assumes individual fault before identifying
the system issue. Option D is unnecessarily broad.
Q7:
A resident's functional status declines substantially over three months. The resident's daughter
claims that staff intentionally allowed the decline to occur. Which administrative response is
MOST appropriate?
A) Immediately accept responsibility
B) Dismiss the allegation because functional decline is common
C) Review assessments, interventions, documentation, outcomes, and contributing factors
through an interdisciplinary process
D) Ask the daughter to stop visiting
Rationale: The correct answer is C because the administrator needs an objective review of the
resident's condition, care provided, documentation, and possible contributing factors. Option A
assumes causation without investigation. Option B improperly dismisses a legitimate concern.
Option D damages the relationship and does not address the issue.
Q8:
NAB CORE EXAM PRACTICE
QUESTIONS, ANSWERS, AND DETAILED
RATIONALES — LATEST STUDY
EDITION
INTRODUCTION
The NAB Core of Knowledge Examination (CORE) is a national examination designed to assess
foundational knowledge applicable across long-term-care administration. NAB describes the
CORE examination as a mandatory component for aspiring administrators and reports it
separately from the line-of-service examinations. The current examination framework is based
on the Domains of Practice established following NAB's Professional Practice Analysis.
For examinations through June 30, 2027, the CORE framework uses four broad domains: Care,
Services, and Supports; Operations; Environment and Quality; and Leadership and
Strategy. NAB has completed a 2026 Professional Practice Analysis that reorganizes the
framework into nine stand-alone domains for examinations beginning July 1, 2027.
This practice bank uses challenging, original, scenario-based questions designed to develop
application, analysis, prioritization, and administrative decision-making skills. Questions
integrate concepts such as person-centered care, finance, human resources, risk management,
quality improvement, regulatory compliance, communication, governance, and strategic
leadership. NAB recommends using multiple references rather than relying on a single study
source.
CONTENT AREA OVERVIEW
| CONTENT AREA | QUESTIONS | KEY TOPICS | SUGGESTED STUDY WEIGHT |
| 1. Care, Services, and Supports | Q1–25 | Person-centered care, resident rights, care
planning, quality of life, interdisciplinary coordination, behavioral health, services and
supports | 25% |
| 2. Operations | Q26–55 | Finance, budgeting, reimbursement, human resources, staffing,
communication, information systems, purchasing, organizational operations | 30% |
| 3. Environment and Quality | Q56–80 | Safety, emergency preparedness, infection
prevention, physical environment, quality improvement, risk management, regulatory
readiness | 25% |
,2|Page
| 4. Leadership and Strategy | Q81–100 | Governance, leadership, ethics, strategic planning,
change management, organizational culture, stakeholder relations, performance
management | 20% |
NOTE: The percentages above are study-allocation weights for this practice bank, not claims
about official NAB item percentages. NAB's currently effective framework through June 30,
2027 consists of the four domains listed above.
QUESTIONS 1–100
DOMAIN 1 — CARE, SERVICES, AND SUPPORTS
Q1:
A long-term-care facility receives repeated complaints that residents with significant cognitive
impairment are being awakened at 5:00 a.m. so staff can complete morning care efficiently. The
director of nursing argues that changing the schedule would disrupt staffing efficiency. Which
administrative action BEST reflects person-centered care?
A) Require all residents to follow the facility's standard morning schedule
B) Establish individualized routines while evaluating staffing and workflow implications
C) Allow residents to refuse all morning care without further intervention
D) Move all residents with cognitive impairment to a separate unit
Rationale: The correct answer is B because person-centered care requires adapting services to
individual preferences and needs while maintaining safe operations. Option A prioritizes
institutional convenience over individual choice. Option C is too absolute because the facility
still has responsibilities for assessment, communication, and safe care planning. Option D
unnecessarily segregates residents and does not address the underlying preference issue.
Q2:
A resident's family requests that staff provide a highly restrictive diet despite the resident
repeatedly expressing a preference for a different diet. The resident has decision-making capacity
and understands the potential consequences. What should the administrator prioritize?
A) The family's request because relatives are responsible for the resident
B) The physician's preference regardless of resident wishes
C) The capable resident's informed preferences while coordinating an appropriate care
plan
D) The facility's standard dietary protocol
,3|Page
Rationale: The correct answer is C because a resident with decision-making capacity generally
has the right to participate in decisions concerning personal care and preferences. Option A
improperly substitutes family preference for the resident's expressed wishes. Option B overstates
the authority of a clinician when the issue involves a capable resident's informed choice. Option
D fails to individualize care.
Q3:
During a care conference, nursing staff report that a resident's repeated nighttime wandering has
increased. The family requests immediate physical restraints. What is the BEST initial
administrative response?
A) Approve restraints because wandering creates liability
B) Transfer the resident to another facility
C) Ensure the interdisciplinary team assesses causes and develops the least restrictive
appropriate interventions
D) Discontinue nighttime monitoring to preserve resident independence
Rationale: The correct answer is C because behavioral changes require assessment and
individualized interventions. Potential contributors may include pain, medication effects,
environmental triggers, sleep disruption, or unmet needs. Option A jumps directly to a restrictive
intervention. Option B avoids the underlying problem. Option D could increase risk rather than
address it.
Q4:
A resident with advanced dementia begins refusing bathing. Staff members believe the refusal is
simply "noncompliance." Which approach is most appropriate?
A) Increase staff pressure until the resident cooperates
B) Schedule disciplinary consequences
C) Assess possible causes of refusal and modify the approach to the resident's needs
D) Permanently discontinue bathing assistance
Rationale: The correct answer is C because refusal can communicate discomfort, fear, pain,
embarrassment, trauma, or another unmet need. Individualized assessment and modification of
the care approach are more appropriate than coercion. Option A can escalate distress. Option B
is inappropriate because care refusal is not a disciplinary issue. Option D abandons necessary
hygiene support.
Q5:
A facility's resident satisfaction survey shows that residents rate meals highly for quality but
poorly for choice. Which intervention would BEST address the finding?
, 4|Page
A) Replace the dietary manager
B) Reduce the number of available menu items
C) Engage residents in menu planning and evaluate preferences against nutritional
requirements
D) Require residents to select meals one month in advance
Rationale: The correct answer is C because resident involvement directly addresses choice while
preserving nutritional and safety requirements. Option A is premature because the data identify
a service issue rather than individual managerial failure. Option B would reduce choice further.
Option D may not accommodate changing preferences or circumstances.
Q6:
A resident's care plan contains several interventions, but direct-care staff cannot explain why one
intervention is being used. What should the administrator do FIRST?
A) Remove the intervention from the care plan
B) Discipline the staff involved
C) Determine whether the care plan is clear, current, and communicated effectively to the
interdisciplinary team
D) Rewrite every resident's care plan
Rationale: The correct answer is C because effective care depends on a current, understandable
plan that is communicated to those responsible for implementation. Option A could eliminate a
necessary intervention without assessment. Option B assumes individual fault before identifying
the system issue. Option D is unnecessarily broad.
Q7:
A resident's functional status declines substantially over three months. The resident's daughter
claims that staff intentionally allowed the decline to occur. Which administrative response is
MOST appropriate?
A) Immediately accept responsibility
B) Dismiss the allegation because functional decline is common
C) Review assessments, interventions, documentation, outcomes, and contributing factors
through an interdisciplinary process
D) Ask the daughter to stop visiting
Rationale: The correct answer is C because the administrator needs an objective review of the
resident's condition, care provided, documentation, and possible contributing factors. Option A
assumes causation without investigation. Option B improperly dismisses a legitimate concern.
Option D damages the relationship and does not address the issue.
Q8:
