Federal Nursing Home Administrator Exam Prep
Document 2026/2027 | NAB Core of Knowledge, Long-
Term Care Management & CMS Regulations | 160
Verified Questions with Detailed Rationales
Abstract
This examination preparation document contains verified questions drawn directly from actual Federal
Nursing Home Administrator Exam content, covering all five NAB Core of Knowledge domains as defined
by the National Association of Long Term Care Administrator Boards. It addresses resident care and
quality of life, regulatory compliance and survey processes, human resources and staffing, financial
management and business operations, and physical environment and risk management. Questions
reflect real-world nursing home administration scenarios, CMS survey findings, regulatory enforcement
actions, and operational challenges candidates must master for NAB licensure.
Content Area Overview
Resident Care, Quality of Life & Clinical Services – Addresses the administrator's role in ensuring
comprehensive resident care, MDS 3.0 assessment and care planning, quality measurement and
improvement, dementia and behavioral health care, medication management, nutrition and hydration,
skin integrity and falls prevention, resident rights and quality of life, and psychosocial and spiritual
support.
Regulatory Compliance & Survey Process – Covers federal requirements for nursing homes under 42 CFR
Part 483, survey protocols and processes, F-tag identification and deficiency classification, plans of
correction, enforcement remedies, resident rights and protections, HIPAA, and OSHA standards, along
with state-specific licensing requirements and their interaction with federal regulations.
Human Resources, Staffing & Employee Relations – Focuses on recruitment and retention, staff
development and training, CNA certification and competency evaluation, mandatory in-service
education, performance management, compliance with labor laws (FLSA, FMLA, ADA), scheduling and
ratios, disciplinary actions, staff safety and workplace violence prevention, and ethical leadership in
long-term care.
Financial Management & Business Operations – Examines budget development, revenue cycle
management, Medicare and Medicaid reimbursement systems, PDPM and case mix, financial reporting
,and cost control, procurement and contracting, marketing and census development, and business
planning and sustainability in long-term care.
Physical Environment, Safety & Risk Management – Covers life safety code compliance (NFPA 101),
maintenance and environmental safety, emergency preparedness and disaster planning, infection
preventionist programs, OSHA workplace safety, risk mitigation, liability prevention, incident reporting
and investigation, root cause analysis, and the administrator's role in fostering a culture of safety.
Section 1: Resident Care, Quality of Life & Clinical Services – Questions 1–38
Q1: A nursing home administrator is reviewing the MDS 3.0 assessment for a newly admitted resident
with moderate-stage Alzheimer's disease. Which section of the MDS is most critical for determining the
resident's cognitive function and potential need for specialized dementia care interventions?
A. Section G: Functional Status
B. Section C: Cognitive Patterns [CORRECT]
C. Section E: Behavior
D. Section K: Swallowing/Nutritional Status
Correct Answer: C
Rationale: The best answer is Section C: Cognitive Patterns. This section directly captures the resident's
cognitive abilities, decision-making capacity, and short- and long-term memory status, which are
essential for developing an appropriate care plan for someone with Alzheimer's disease. While Section E
addresses behaviors, it doesn't assess underlying cognitive function the way Section C does.
Q2: During a quarterly care plan review, the interdisciplinary team notes that a resident with diabetes
has had three episodes of hypoglycemia in the past month. Per CMS guidelines, what is the
administrator's best next step to ensure proper care plan revision?
A. Instruct the nursing staff to check blood glucose more frequently without changing the care plan
B. Convene the interdisciplinary team to reassess the resident's care plan and medication regimen
[CORRECT]
C. Document the episodes in the medical record and continue current interventions
D. Transfer the resident to the hospital for endocrinology consultation
Correct Answer: B
Rationale: This choice is correct because CMS requires that significant changes in a resident's condition
trigger a care plan reassessment by the interdisciplinary team. Three hypoglycemic episodes represent a
,meaningful change that demands review of both the care plan and medication management, not just
more frequent monitoring or passive documentation.
Q3: A resident's family complains that their mother, who has advanced dementia, is being restrained
with a lap belt in her wheelchair during meals. The administrator investigates and finds this has been
routine practice for two weeks. What federal regulation most directly prohibits this practice?
A. 42 CFR §483.12, Resident Rights
B. 42 CFR §483.13, Resident Behavior and Facility Practices [CORRECT]
C. 42 CFR §483.24, Quality of Life
D. 42 CFR §483.25, Quality of Care
Correct Answer: B
Rationale: This aligns with 42 CFR §483.13, which specifically addresses the use of restraints in nursing
homes and requires that any restraint be medically necessary, ordered by a physician, and used only to
treat a medical symptom—not for staff convenience. A lap belt used routinely during meals without
medical justification violates this regulation.
Q4: The facility's wound care nurse reports that a resident developed a Stage 2 pressure injury on his
sacrum within 48 hours of admission. According to CMS guidelines, when must the facility complete a
comprehensive assessment and implement interventions?
A. Within 24 hours of discovery
B. Within 48 hours of discovery
C. Immediately, with documentation and care plan revision as soon as possible [CORRECT]
D. At the next scheduled care plan conference
Correct Answer: C
Rationale: This matches the regulatory requirement that facilities must act immediately when a pressure
injury is identified, regardless of when it developed. The administrator needs to ensure prompt
assessment, intervention, and care plan updates—waiting for a scheduled conference or an arbitrary 24-
48 hour window doesn't meet the standard of timely response.
Q5: A nursing home is implementing a new falls prevention program. Which intervention has the
strongest evidence base for reducing falls in long-term care residents?
A. Installing bed alarms on all resident beds
B. Conducting a multifactorial falls risk assessment and tailoring interventions to individual risk factors
[CORRECT]
, C. Requiring all residents to use walkers
D. Increasing lighting in all hallways by 50%
Correct Answer: B
Rationale: The best answer is a multifactorial assessment with individualized interventions. Research
consistently shows that blanket approaches like bed alarms or universal walker use aren't as effective as
identifying each resident's specific risk factors—such as gait instability, medication effects, or orthostatic
hypotension—and addressing them directly.
Q6: A resident with end-stage renal disease on dialysis is refusing to follow the prescribed renal diet and
is requesting unrestricted access to high-potassium foods. The administrator is consulted. Which action
best upholds resident rights while ensuring appropriate care?
A. Honor the refusal completely and remove all dietary restrictions
B. Override the refusal and enforce the renal diet strictly
C. Ensure the resident has been informed of the risks, document the refusal, and work with the dietitian
to find acceptable compromises [CORRECT]
D. Transfer the resident to a facility that doesn't provide renal diets
Correct Answer: C
Rationale: This choice is correct because it balances the resident's right to refuse treatment with the
facility's duty to educate and protect. The administrator should verify informed refusal is documented,
then collaborate with the dietitian to minimize harm while respecting autonomy—rather than simply
giving up or overriding the resident's wishes entirely.
Q7: The Minimum Data Set (MDS) 3.0 assessment must be completed within what timeframe after a
resident's admission to a Medicare-certified nursing home?
A. Within 7 days
B. Within 14 days [CORRECT]
C. Within 21 days
D. Within 30 days
Correct Answer: B
Rationale: This aligns with the CMS requirement that the comprehensive MDS 3.0 assessment be
completed within 14 days of admission. The assessment window is actually days 1-14, with the
assessment reference date typically set within that window, making this a key compliance deadline
every administrator must track.
Document 2026/2027 | NAB Core of Knowledge, Long-
Term Care Management & CMS Regulations | 160
Verified Questions with Detailed Rationales
Abstract
This examination preparation document contains verified questions drawn directly from actual Federal
Nursing Home Administrator Exam content, covering all five NAB Core of Knowledge domains as defined
by the National Association of Long Term Care Administrator Boards. It addresses resident care and
quality of life, regulatory compliance and survey processes, human resources and staffing, financial
management and business operations, and physical environment and risk management. Questions
reflect real-world nursing home administration scenarios, CMS survey findings, regulatory enforcement
actions, and operational challenges candidates must master for NAB licensure.
Content Area Overview
Resident Care, Quality of Life & Clinical Services – Addresses the administrator's role in ensuring
comprehensive resident care, MDS 3.0 assessment and care planning, quality measurement and
improvement, dementia and behavioral health care, medication management, nutrition and hydration,
skin integrity and falls prevention, resident rights and quality of life, and psychosocial and spiritual
support.
Regulatory Compliance & Survey Process – Covers federal requirements for nursing homes under 42 CFR
Part 483, survey protocols and processes, F-tag identification and deficiency classification, plans of
correction, enforcement remedies, resident rights and protections, HIPAA, and OSHA standards, along
with state-specific licensing requirements and their interaction with federal regulations.
Human Resources, Staffing & Employee Relations – Focuses on recruitment and retention, staff
development and training, CNA certification and competency evaluation, mandatory in-service
education, performance management, compliance with labor laws (FLSA, FMLA, ADA), scheduling and
ratios, disciplinary actions, staff safety and workplace violence prevention, and ethical leadership in
long-term care.
Financial Management & Business Operations – Examines budget development, revenue cycle
management, Medicare and Medicaid reimbursement systems, PDPM and case mix, financial reporting
,and cost control, procurement and contracting, marketing and census development, and business
planning and sustainability in long-term care.
Physical Environment, Safety & Risk Management – Covers life safety code compliance (NFPA 101),
maintenance and environmental safety, emergency preparedness and disaster planning, infection
preventionist programs, OSHA workplace safety, risk mitigation, liability prevention, incident reporting
and investigation, root cause analysis, and the administrator's role in fostering a culture of safety.
Section 1: Resident Care, Quality of Life & Clinical Services – Questions 1–38
Q1: A nursing home administrator is reviewing the MDS 3.0 assessment for a newly admitted resident
with moderate-stage Alzheimer's disease. Which section of the MDS is most critical for determining the
resident's cognitive function and potential need for specialized dementia care interventions?
A. Section G: Functional Status
B. Section C: Cognitive Patterns [CORRECT]
C. Section E: Behavior
D. Section K: Swallowing/Nutritional Status
Correct Answer: C
Rationale: The best answer is Section C: Cognitive Patterns. This section directly captures the resident's
cognitive abilities, decision-making capacity, and short- and long-term memory status, which are
essential for developing an appropriate care plan for someone with Alzheimer's disease. While Section E
addresses behaviors, it doesn't assess underlying cognitive function the way Section C does.
Q2: During a quarterly care plan review, the interdisciplinary team notes that a resident with diabetes
has had three episodes of hypoglycemia in the past month. Per CMS guidelines, what is the
administrator's best next step to ensure proper care plan revision?
A. Instruct the nursing staff to check blood glucose more frequently without changing the care plan
B. Convene the interdisciplinary team to reassess the resident's care plan and medication regimen
[CORRECT]
C. Document the episodes in the medical record and continue current interventions
D. Transfer the resident to the hospital for endocrinology consultation
Correct Answer: B
Rationale: This choice is correct because CMS requires that significant changes in a resident's condition
trigger a care plan reassessment by the interdisciplinary team. Three hypoglycemic episodes represent a
,meaningful change that demands review of both the care plan and medication management, not just
more frequent monitoring or passive documentation.
Q3: A resident's family complains that their mother, who has advanced dementia, is being restrained
with a lap belt in her wheelchair during meals. The administrator investigates and finds this has been
routine practice for two weeks. What federal regulation most directly prohibits this practice?
A. 42 CFR §483.12, Resident Rights
B. 42 CFR §483.13, Resident Behavior and Facility Practices [CORRECT]
C. 42 CFR §483.24, Quality of Life
D. 42 CFR §483.25, Quality of Care
Correct Answer: B
Rationale: This aligns with 42 CFR §483.13, which specifically addresses the use of restraints in nursing
homes and requires that any restraint be medically necessary, ordered by a physician, and used only to
treat a medical symptom—not for staff convenience. A lap belt used routinely during meals without
medical justification violates this regulation.
Q4: The facility's wound care nurse reports that a resident developed a Stage 2 pressure injury on his
sacrum within 48 hours of admission. According to CMS guidelines, when must the facility complete a
comprehensive assessment and implement interventions?
A. Within 24 hours of discovery
B. Within 48 hours of discovery
C. Immediately, with documentation and care plan revision as soon as possible [CORRECT]
D. At the next scheduled care plan conference
Correct Answer: C
Rationale: This matches the regulatory requirement that facilities must act immediately when a pressure
injury is identified, regardless of when it developed. The administrator needs to ensure prompt
assessment, intervention, and care plan updates—waiting for a scheduled conference or an arbitrary 24-
48 hour window doesn't meet the standard of timely response.
Q5: A nursing home is implementing a new falls prevention program. Which intervention has the
strongest evidence base for reducing falls in long-term care residents?
A. Installing bed alarms on all resident beds
B. Conducting a multifactorial falls risk assessment and tailoring interventions to individual risk factors
[CORRECT]
, C. Requiring all residents to use walkers
D. Increasing lighting in all hallways by 50%
Correct Answer: B
Rationale: The best answer is a multifactorial assessment with individualized interventions. Research
consistently shows that blanket approaches like bed alarms or universal walker use aren't as effective as
identifying each resident's specific risk factors—such as gait instability, medication effects, or orthostatic
hypotension—and addressing them directly.
Q6: A resident with end-stage renal disease on dialysis is refusing to follow the prescribed renal diet and
is requesting unrestricted access to high-potassium foods. The administrator is consulted. Which action
best upholds resident rights while ensuring appropriate care?
A. Honor the refusal completely and remove all dietary restrictions
B. Override the refusal and enforce the renal diet strictly
C. Ensure the resident has been informed of the risks, document the refusal, and work with the dietitian
to find acceptable compromises [CORRECT]
D. Transfer the resident to a facility that doesn't provide renal diets
Correct Answer: C
Rationale: This choice is correct because it balances the resident's right to refuse treatment with the
facility's duty to educate and protect. The administrator should verify informed refusal is documented,
then collaborate with the dietitian to minimize harm while respecting autonomy—rather than simply
giving up or overriding the resident's wishes entirely.
Q7: The Minimum Data Set (MDS) 3.0 assessment must be completed within what timeframe after a
resident's admission to a Medicare-certified nursing home?
A. Within 7 days
B. Within 14 days [CORRECT]
C. Within 21 days
D. Within 30 days
Correct Answer: B
Rationale: This aligns with the CMS requirement that the comprehensive MDS 3.0 assessment be
completed within 14 days of admission. The assessment window is actually days 1-14, with the
assessment reference date typically set within that window, making this a key compliance deadline
every administrator must track.
