FEDERAL NURSING HOME ADMINISTRATOR (LNHA) EXAMINATION
2026/2027: MASTER STUDY GUIDE & PRACTICE TEST
"200+ Fully Verified Multiple-Choice Questions, Detailed Rationales,
and Core Concept Review Covering OBRA Regulations, Resident
Rights, Facility Financial Management, Infection Control, QAPI
Committees, and Administrative Responsibilities for First-Attempt
Success."
1. A resident is admitted to a long-term care facility and requests to see their
own medical record. The attending physician instructs the nurse not to allow the
resident to view it. What is the appropriate legal action for the facility?
A. Comply with the physician’s order to protect the resident's emotional well-
being
B. Inform the physician that the resident has a legal right to access their medical
record
C. Allow the resident to see the record only if a family member signs a release
form
D. Ask the medical director to review the chart first and redact sensitive
information
Correct Answer: B
Rationale: Federal regulations (under OBRA and HIPAA) grant residents the
absolute right to access their medical records. Physicians cannot override this
federal law; facility staff must advocate for the resident’s rights.
2. When calculating the average daily occupancy rate for a nursing home, which
of the following formulas is used?
A. Total admissions divided by total discharges
B. Number of empty beds multiplied by total days in the month
C. Total occupied bed days divided by the total number of days, multiplied by 100
,D. Number of Medicare days divided by total bed capacity
Correct Answer: C
Rationale: Average percent of occupancy is calculated by taking the total number
of occupied bed days (census) and dividing it by the total number of beds
available over a specific period (e.g., days in the month or year), then multiplying
by 100.
3. According to federal law, how long must a nursing home retain menus of food
actually served to residents?
A. 7 days
B. 14 days
C. 30 days
D. 60 days
Correct Answer: C
Rationale: Federal regulations require long-term care facilities to retain menus of
the food actually served for at least 30 days to ensure oversight of dietary
compliance and quality.
4. A resident has a valid living will requesting "heroic measures" and a DPOA.
The resident is now incompetent and requires CPR. The resident’s son, holding
the DPOA, requests that CPR be withheld. What is the correct action for the
administrator?
A. Follow the son's request because he holds the DPOA
B. Withhold CPR to avoid family conflict
C. Provide CPR as stipulated by the resident’s documented living will
D. Seek a court order to determine the son's authority before acting
Correct Answer: C
Rationale: A DPOA cannot override a resident’s explicit written wishes, especially
regarding life-sustaining treatment. The living will takes precedence, and the
facility must honor the resident's prior competent wishes.
5. Which of the following committees can legally be folded into the facility's
Quality Assurance/Quality Improvement (QA/QI) committee under OBRA
regulations?
,A. Medical Records Committee
B. Infection Control Committee
C. Fundraising Committee
D. Staffing Committee
Correct Answer: B
Rationale: OBRA mandates that certain committees, including Safety, Pharmacy,
and Infection Control, can be integrated into the QA/QI committee to streamline
oversight and improve the facility's overall quality assurance approach.
6. If an emergency arises at night and neither the attending physician nor the
back-up physician is available, who is legally responsible for making the final
decision regarding who will attend to the resident?
A. The Director of Nursing (DON)
B. The charge nurse on duty
C. The attending physician's medical resident
D. The Administrator
Correct Answer: D
Rationale: Ultimately, the administrator is responsible for ensuring that the facility
has protocols in place to guarantee resident care. If no physician is available, the
facility’s administrative leadership is responsible for ensuring a qualified provider
or emergency services are utilized.
7. A resident is dually eligible for both Medicaid and Medicare. Which of the
following is a facility legally allowed to charge the resident?
A. Monthly rent
B. Co-pays
C. Administrative fees
D. Cost of laundry services
Correct Answer: B
Rationale: The law strictly prohibits charging a dually eligible resident for services
covered by Medicare or Medicaid. The only permissible charge is the specific co-
pay amount defined by the state and federal regulations.
, 8. A facility must provide dental care for its residents. However, who is
responsible for paying for these dental services?
A. The facility
B. Medicare Part A
C. The resident or their family member
D. The State Medicaid agency regardless of eligibility
Correct Answer: C
Rationale: While the facility is responsible for arranging and ensuring residents
obtain dental care, the cost of these services is usually the responsibility of the
resident or their family, unless covered by specific Medicaid state plans or
supplemental insurance.
9. Physical restraints must be removed and residents must be given the
opportunity to move freely at least how often?
A. Every hour
B. Every two hours
C. Every four hours
D. Every shift
Correct Answer: B
Rationale: Federal regulations mandate strict guidelines on the use of restraints to
prevent injury. Restraints must be released, and residents provided with range-of-
motion activities and bathroom opportunities, at least every two hours.
10. Which of the following is NOT considered a normal psychological change
associated with the aging process?
A. Depression
B. Slower reaction times
C. Increased memory retrieval times
D. Hearing loss
Correct Answer: A
Rationale: Depression is a pathological condition, not a normal psychological
change of aging. While hearing loss and slowed reactions occur, persistent
depression is a medical diagnosis that requires treatment, not a standard process.
2026/2027: MASTER STUDY GUIDE & PRACTICE TEST
"200+ Fully Verified Multiple-Choice Questions, Detailed Rationales,
and Core Concept Review Covering OBRA Regulations, Resident
Rights, Facility Financial Management, Infection Control, QAPI
Committees, and Administrative Responsibilities for First-Attempt
Success."
1. A resident is admitted to a long-term care facility and requests to see their
own medical record. The attending physician instructs the nurse not to allow the
resident to view it. What is the appropriate legal action for the facility?
A. Comply with the physician’s order to protect the resident's emotional well-
being
B. Inform the physician that the resident has a legal right to access their medical
record
C. Allow the resident to see the record only if a family member signs a release
form
D. Ask the medical director to review the chart first and redact sensitive
information
Correct Answer: B
Rationale: Federal regulations (under OBRA and HIPAA) grant residents the
absolute right to access their medical records. Physicians cannot override this
federal law; facility staff must advocate for the resident’s rights.
2. When calculating the average daily occupancy rate for a nursing home, which
of the following formulas is used?
A. Total admissions divided by total discharges
B. Number of empty beds multiplied by total days in the month
C. Total occupied bed days divided by the total number of days, multiplied by 100
,D. Number of Medicare days divided by total bed capacity
Correct Answer: C
Rationale: Average percent of occupancy is calculated by taking the total number
of occupied bed days (census) and dividing it by the total number of beds
available over a specific period (e.g., days in the month or year), then multiplying
by 100.
3. According to federal law, how long must a nursing home retain menus of food
actually served to residents?
A. 7 days
B. 14 days
C. 30 days
D. 60 days
Correct Answer: C
Rationale: Federal regulations require long-term care facilities to retain menus of
the food actually served for at least 30 days to ensure oversight of dietary
compliance and quality.
4. A resident has a valid living will requesting "heroic measures" and a DPOA.
The resident is now incompetent and requires CPR. The resident’s son, holding
the DPOA, requests that CPR be withheld. What is the correct action for the
administrator?
A. Follow the son's request because he holds the DPOA
B. Withhold CPR to avoid family conflict
C. Provide CPR as stipulated by the resident’s documented living will
D. Seek a court order to determine the son's authority before acting
Correct Answer: C
Rationale: A DPOA cannot override a resident’s explicit written wishes, especially
regarding life-sustaining treatment. The living will takes precedence, and the
facility must honor the resident's prior competent wishes.
5. Which of the following committees can legally be folded into the facility's
Quality Assurance/Quality Improvement (QA/QI) committee under OBRA
regulations?
,A. Medical Records Committee
B. Infection Control Committee
C. Fundraising Committee
D. Staffing Committee
Correct Answer: B
Rationale: OBRA mandates that certain committees, including Safety, Pharmacy,
and Infection Control, can be integrated into the QA/QI committee to streamline
oversight and improve the facility's overall quality assurance approach.
6. If an emergency arises at night and neither the attending physician nor the
back-up physician is available, who is legally responsible for making the final
decision regarding who will attend to the resident?
A. The Director of Nursing (DON)
B. The charge nurse on duty
C. The attending physician's medical resident
D. The Administrator
Correct Answer: D
Rationale: Ultimately, the administrator is responsible for ensuring that the facility
has protocols in place to guarantee resident care. If no physician is available, the
facility’s administrative leadership is responsible for ensuring a qualified provider
or emergency services are utilized.
7. A resident is dually eligible for both Medicaid and Medicare. Which of the
following is a facility legally allowed to charge the resident?
A. Monthly rent
B. Co-pays
C. Administrative fees
D. Cost of laundry services
Correct Answer: B
Rationale: The law strictly prohibits charging a dually eligible resident for services
covered by Medicare or Medicaid. The only permissible charge is the specific co-
pay amount defined by the state and federal regulations.
, 8. A facility must provide dental care for its residents. However, who is
responsible for paying for these dental services?
A. The facility
B. Medicare Part A
C. The resident or their family member
D. The State Medicaid agency regardless of eligibility
Correct Answer: C
Rationale: While the facility is responsible for arranging and ensuring residents
obtain dental care, the cost of these services is usually the responsibility of the
resident or their family, unless covered by specific Medicaid state plans or
supplemental insurance.
9. Physical restraints must be removed and residents must be given the
opportunity to move freely at least how often?
A. Every hour
B. Every two hours
C. Every four hours
D. Every shift
Correct Answer: B
Rationale: Federal regulations mandate strict guidelines on the use of restraints to
prevent injury. Restraints must be released, and residents provided with range-of-
motion activities and bathroom opportunities, at least every two hours.
10. Which of the following is NOT considered a normal psychological change
associated with the aging process?
A. Depression
B. Slower reaction times
C. Increased memory retrieval times
D. Hearing loss
Correct Answer: A
Rationale: Depression is a pathological condition, not a normal psychological
change of aging. While hearing loss and slowed reactions occur, persistent
depression is a medical diagnosis that requires treatment, not a standard process.
