RCAL NAB ADMINISTRATOR EXAM
Questions And Correct Answers With
Rationales
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
150 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This examination assesses mastery of the core domains tested on the NAB (National Association of Long
Term Care Administrator Boards) licensure examination for Residential Care/Assisted Living (RCAL)
administrators. It integrates federal regulatory standards, geriatric clinical care, financial management, human
resources, physical environment, and leadership/governance content required for state licensure as a nursing
home or assisted living administrator.
STUDY GUIDE
Recommended duration: 2 hours 30 minutes. Passing target: 75% (C or better for graduate credit; 80%
recommended for licensure readiness).
HIGHP - Page 1 of 53
,1. Under the current CMS Requirements of Participation, which of the following best
describes the administrator's responsibility when a facility receives a citation at scope
and severity level 'G' (actual harm, isolated)?
[ ] A. The facility must submit a plan of correction within 10 calendar days and may continue operating
without further action.
[ ] B. The facility must submit an acceptable plan of correction within 10 working days, and CMS may
impose denial of payment for new admissions if the deficiency is not corrected.
[ ] C. The facility is automatically placed on the Special Focus Facility list and must hire an independent
monitor.
[ ] D. The citation is considered de minimis and requires only documentation in the quality assurance
log.
CORRECT: B. The facility must submit an acceptable plan of correction within 10 working days, and
CMS may impose denial of payment for new admissions if the deficiency is not corrected.
Level G represents actual harm that is isolated, and CMS requires an acceptable plan of correction within 10
working days; denial of payment for new admissions is a permissible enforcement remedy. Option A is wrong
because 10 calendar days applies to other deficiency categories and ignores enforcement remedies. C is
incorrect because Special Focus Facility designation requires a pattern of persistent deficiencies, not a single
G citation. D is wrong because de minimis citations are level A, not G.
2. An RCAL administrator is reviewing the facility's financial statements and notes that the
current ratio has declined from 2.1 to 1.3 over two years, while the days-cash-on-hand has
dropped from 45 to 18 days. Which action best addresses the underlying financial risk?
[ ] A. Increase the marketing budget to boost census and revenue.
[ ] B. Refinance long-term debt to extend maturity dates.
[ ] C. Accelerate accounts receivable collection and renegotiate vendor payment terms to improve
short-term liquidity.
[ ] D. Reduce the direct care staffing ratio to lower operating expenses.
CORRECT: C. Accelerate accounts receivable collection and renegotiate vendor payment terms to
improve short-term liquidity.
A declining current ratio and low days-cash-on-hand indicate liquidity stress; accelerating receivables and
extending payables directly improve cash position. A is wrong because increased marketing does not
address immediate liquidity and may worsen cash outflow. B addresses solvency structure, not short-term
liquidity. D is inappropriate because reducing direct care staffing jeopardizes quality and regulatory
compliance.
3. Which of the following best reflects the administrator's role in ensuring compliance with
the Health Insurance Portability and Accountability Act (HIPAA) in an assisted living
setting?
[ ] A. Ensuring that all staff receive annual HIPAA training and that business associate agreements are
in place with vendors handling protected health information.
HIGHP - Page 2 of 53
, [ ] B. Personally reviewing every resident's medical record to verify accuracy before release.
[ ] C. Delegating all HIPAA compliance responsibilities to the facility's legal counsel.
[ ] D. Restricting all verbal communication about residents to written memos only.
CORRECT: A. Ensuring that all staff receive annual HIPAA training and that business associate
agreements are in place with vendors handling protected health information.
HIPAA requires covered entities to train workforce members and to have business associate agreements with
vendors who access protected health information. B is impractical and not a required administrative control.
C is incorrect because the administrator retains ultimate compliance responsibility. D misinterprets HIPAA,
which permits necessary verbal communication for treatment and operations.
4. A resident with advanced dementia has a physician order for a feeding tube, but the
resident's advance directive clearly states 'no artificial nutrition or hydration.' The
administrator's most appropriate action is to:
[ ] A. Follow the physician order because it is the most recent clinical instruction.
[ ] B. Initiate the facility's ethics consultation process and ensure the resident's documented wishes are
honored pending resolution.
[ ] C. Ask the resident's family to override the advance directive.
[ ] D. Transfer the resident to an acute care hospital for tube placement.
CORRECT: B. Initiate the facility's ethics consultation process and ensure the resident's documented
wishes are honored pending resolution.
Advance directives are legally binding, and the administrator should ensure the resident's documented
wishes are respected while engaging the ethics committee to resolve the conflict. A is wrong because a
physician order cannot override a valid advance directive. C is incorrect because family cannot supersede a
clear advance directive. D violates the resident's right to refuse treatment.
5. In the context of the Americans with Disabilities Act (ADA) and the Fair Housing Act,
which statement is most accurate regarding reasonable accommodations in an assisted
living facility?
[ ] A. Facilities may charge extra fees for reasonable accommodations to offset costs.
[ ] B. Reasonable accommodations must be provided unless they impose an undue financial and
administrative burden or fundamentally alter the nature of the facility's operations.
[ ] C. Reasonable accommodations are only required for residents who are wheelchair-bound.
[ ] D. The facility may deny accommodations if the resident did not disclose the disability at admission.
CORRECT: B. Reasonable accommodations must be provided unless they impose an undue financial
and administrative burden or fundamentally alter the nature of the facility's operations.
Under the ADA and FHA, reasonable accommodations must be provided unless they cause undue burden or
fundamental alteration. A is incorrect because surcharges for accommodations are generally prohibited. C is
too narrow; accommodations apply to a wide range of disabilities. D is wrong because residents may request
accommodations at any time, and disclosure at admission is not required.
HIGHP - Page 3 of 53
, 6. A facility's quality assurance and performance improvement (QAPI) committee is
analyzing data showing a rising rate of falls with injury. Which of the following is the most
appropriate first step in the QAPI process?
[ ] A. Implement a new fall prevention protocol immediately.
[ ] B. Conduct a root cause analysis to identify contributing factors and gaps in care.
[ ] C. Increase staffing on all shifts.
[ ] D. Report the data to the state survey agency.
CORRECT: B. Conduct a root cause analysis to identify contributing factors and gaps in care.
The QAPI framework begins with identifying and analyzing the problem through root cause analysis before
implementing interventions. A skips the analysis phase and may not address the true cause. C is a
premature solution without evidence. D is not required unless there is a regulatory reporting mandate, and it
does not address the underlying issue.
7. Which of the following best describes the administrator's responsibility regarding the
Life Safety Code (NFPA 101) in a long-term care facility?
[ ] A. Ensuring that the facility maintains an approved fire safety plan, conducts regular drills, and
corrects identified deficiencies.
[ ] B. Delegating all fire safety responsibilities to the local fire marshal.
[ ] C. Conducting fire drills only when required by the state survey agency.
[ ] D. Installing sprinklers only in resident rooms.
CORRECT: A. Ensuring that the facility maintains an approved fire safety plan, conducts regular
drills, and corrects identified deficiencies.
The administrator must ensure compliance with the Life Safety Code, including maintaining a fire safety plan,
conducting drills, and correcting deficiencies. B is incorrect because ultimate responsibility remains with the
facility. C is wrong because drills must be conducted at required frequencies regardless of surveys. D is
inadequate because sprinkler coverage must meet code throughout the facility.
8. An administrator is evaluating staffing needs for a 120-bed skilled nursing facility.
Which of the following factors is most critical in determining the appropriate direct care
staffing levels?
[ ] A. The facility's historical staffing patterns.
[ ] B. Resident acuity and case-mix as determined by assessments such as the MDS.
[ ] C. The number of private-pay residents.
[ ] D. The administrator's personal preference for staffing ratios.
CORRECT: B. Resident acuity and case-mix as determined by assessments such as the MDS.
Staffing levels must be based on resident acuity and case-mix, which are captured through the Minimum
Data Set (MDS) and other assessments. A is insufficient because historical patterns may not reflect current
needs. C is not a reliable indicator of care needs. D is inappropriate because staffing should be
HIGHP - Page 4 of 53
Questions And Correct Answers With
Rationales
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
150 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This examination assesses mastery of the core domains tested on the NAB (National Association of Long
Term Care Administrator Boards) licensure examination for Residential Care/Assisted Living (RCAL)
administrators. It integrates federal regulatory standards, geriatric clinical care, financial management, human
resources, physical environment, and leadership/governance content required for state licensure as a nursing
home or assisted living administrator.
STUDY GUIDE
Recommended duration: 2 hours 30 minutes. Passing target: 75% (C or better for graduate credit; 80%
recommended for licensure readiness).
HIGHP - Page 1 of 53
,1. Under the current CMS Requirements of Participation, which of the following best
describes the administrator's responsibility when a facility receives a citation at scope
and severity level 'G' (actual harm, isolated)?
[ ] A. The facility must submit a plan of correction within 10 calendar days and may continue operating
without further action.
[ ] B. The facility must submit an acceptable plan of correction within 10 working days, and CMS may
impose denial of payment for new admissions if the deficiency is not corrected.
[ ] C. The facility is automatically placed on the Special Focus Facility list and must hire an independent
monitor.
[ ] D. The citation is considered de minimis and requires only documentation in the quality assurance
log.
CORRECT: B. The facility must submit an acceptable plan of correction within 10 working days, and
CMS may impose denial of payment for new admissions if the deficiency is not corrected.
Level G represents actual harm that is isolated, and CMS requires an acceptable plan of correction within 10
working days; denial of payment for new admissions is a permissible enforcement remedy. Option A is wrong
because 10 calendar days applies to other deficiency categories and ignores enforcement remedies. C is
incorrect because Special Focus Facility designation requires a pattern of persistent deficiencies, not a single
G citation. D is wrong because de minimis citations are level A, not G.
2. An RCAL administrator is reviewing the facility's financial statements and notes that the
current ratio has declined from 2.1 to 1.3 over two years, while the days-cash-on-hand has
dropped from 45 to 18 days. Which action best addresses the underlying financial risk?
[ ] A. Increase the marketing budget to boost census and revenue.
[ ] B. Refinance long-term debt to extend maturity dates.
[ ] C. Accelerate accounts receivable collection and renegotiate vendor payment terms to improve
short-term liquidity.
[ ] D. Reduce the direct care staffing ratio to lower operating expenses.
CORRECT: C. Accelerate accounts receivable collection and renegotiate vendor payment terms to
improve short-term liquidity.
A declining current ratio and low days-cash-on-hand indicate liquidity stress; accelerating receivables and
extending payables directly improve cash position. A is wrong because increased marketing does not
address immediate liquidity and may worsen cash outflow. B addresses solvency structure, not short-term
liquidity. D is inappropriate because reducing direct care staffing jeopardizes quality and regulatory
compliance.
3. Which of the following best reflects the administrator's role in ensuring compliance with
the Health Insurance Portability and Accountability Act (HIPAA) in an assisted living
setting?
[ ] A. Ensuring that all staff receive annual HIPAA training and that business associate agreements are
in place with vendors handling protected health information.
HIGHP - Page 2 of 53
, [ ] B. Personally reviewing every resident's medical record to verify accuracy before release.
[ ] C. Delegating all HIPAA compliance responsibilities to the facility's legal counsel.
[ ] D. Restricting all verbal communication about residents to written memos only.
CORRECT: A. Ensuring that all staff receive annual HIPAA training and that business associate
agreements are in place with vendors handling protected health information.
HIPAA requires covered entities to train workforce members and to have business associate agreements with
vendors who access protected health information. B is impractical and not a required administrative control.
C is incorrect because the administrator retains ultimate compliance responsibility. D misinterprets HIPAA,
which permits necessary verbal communication for treatment and operations.
4. A resident with advanced dementia has a physician order for a feeding tube, but the
resident's advance directive clearly states 'no artificial nutrition or hydration.' The
administrator's most appropriate action is to:
[ ] A. Follow the physician order because it is the most recent clinical instruction.
[ ] B. Initiate the facility's ethics consultation process and ensure the resident's documented wishes are
honored pending resolution.
[ ] C. Ask the resident's family to override the advance directive.
[ ] D. Transfer the resident to an acute care hospital for tube placement.
CORRECT: B. Initiate the facility's ethics consultation process and ensure the resident's documented
wishes are honored pending resolution.
Advance directives are legally binding, and the administrator should ensure the resident's documented
wishes are respected while engaging the ethics committee to resolve the conflict. A is wrong because a
physician order cannot override a valid advance directive. C is incorrect because family cannot supersede a
clear advance directive. D violates the resident's right to refuse treatment.
5. In the context of the Americans with Disabilities Act (ADA) and the Fair Housing Act,
which statement is most accurate regarding reasonable accommodations in an assisted
living facility?
[ ] A. Facilities may charge extra fees for reasonable accommodations to offset costs.
[ ] B. Reasonable accommodations must be provided unless they impose an undue financial and
administrative burden or fundamentally alter the nature of the facility's operations.
[ ] C. Reasonable accommodations are only required for residents who are wheelchair-bound.
[ ] D. The facility may deny accommodations if the resident did not disclose the disability at admission.
CORRECT: B. Reasonable accommodations must be provided unless they impose an undue financial
and administrative burden or fundamentally alter the nature of the facility's operations.
Under the ADA and FHA, reasonable accommodations must be provided unless they cause undue burden or
fundamental alteration. A is incorrect because surcharges for accommodations are generally prohibited. C is
too narrow; accommodations apply to a wide range of disabilities. D is wrong because residents may request
accommodations at any time, and disclosure at admission is not required.
HIGHP - Page 3 of 53
, 6. A facility's quality assurance and performance improvement (QAPI) committee is
analyzing data showing a rising rate of falls with injury. Which of the following is the most
appropriate first step in the QAPI process?
[ ] A. Implement a new fall prevention protocol immediately.
[ ] B. Conduct a root cause analysis to identify contributing factors and gaps in care.
[ ] C. Increase staffing on all shifts.
[ ] D. Report the data to the state survey agency.
CORRECT: B. Conduct a root cause analysis to identify contributing factors and gaps in care.
The QAPI framework begins with identifying and analyzing the problem through root cause analysis before
implementing interventions. A skips the analysis phase and may not address the true cause. C is a
premature solution without evidence. D is not required unless there is a regulatory reporting mandate, and it
does not address the underlying issue.
7. Which of the following best describes the administrator's responsibility regarding the
Life Safety Code (NFPA 101) in a long-term care facility?
[ ] A. Ensuring that the facility maintains an approved fire safety plan, conducts regular drills, and
corrects identified deficiencies.
[ ] B. Delegating all fire safety responsibilities to the local fire marshal.
[ ] C. Conducting fire drills only when required by the state survey agency.
[ ] D. Installing sprinklers only in resident rooms.
CORRECT: A. Ensuring that the facility maintains an approved fire safety plan, conducts regular
drills, and corrects identified deficiencies.
The administrator must ensure compliance with the Life Safety Code, including maintaining a fire safety plan,
conducting drills, and correcting deficiencies. B is incorrect because ultimate responsibility remains with the
facility. C is wrong because drills must be conducted at required frequencies regardless of surveys. D is
inadequate because sprinkler coverage must meet code throughout the facility.
8. An administrator is evaluating staffing needs for a 120-bed skilled nursing facility.
Which of the following factors is most critical in determining the appropriate direct care
staffing levels?
[ ] A. The facility's historical staffing patterns.
[ ] B. Resident acuity and case-mix as determined by assessments such as the MDS.
[ ] C. The number of private-pay residents.
[ ] D. The administrator's personal preference for staffing ratios.
CORRECT: B. Resident acuity and case-mix as determined by assessments such as the MDS.
Staffing levels must be based on resident acuity and case-mix, which are captured through the Minimum
Data Set (MDS) and other assessments. A is insufficient because historical patterns may not reflect current
needs. C is not a reliable indicator of care needs. D is inappropriate because staffing should be
HIGHP - Page 4 of 53
