FEDERAL NURSING HOME ADMINISTRATOR EXAM NAB
Core of Knowledge & CMS Compliance — 200 Questions &
Detailed Answers Based on NAB Domains | CMS Conditions
of Participation | Latest 2026/2027 Guidelines
| |Care, Services, and Supports | 1–55 | 45% |
| | Resident Rights & Quality of Life | 1–20 | |
| | Person-Centered Care & Care Planning | 21–35 | |
| | MDS Assessments & Clinical Services | 36–45 | |
| | Psychosocial Wellbeing & Abuse Prevention | 46–55 | |
| II | Operations| 56–110 | 28% |
| | Human Resources Management | 56–80 | |
| | Financial Management & Reimbursement | 81–100 | |
| | Regulatory Compliance & Survey Process | 101–110 | |
| III | Environment and Quality| 111–155 | 27% |
| | Physical Environment & Life Safety | 111–130 | |
| | Infection Prevention & Control | 131–145 | |
| | Quality Assurance & Performance Improvement (QAPI) | 146–155 | |
| IV | Leadership and Strategy** | 156–200 | 0%* |
| | Leadership & Organizational Management | 156–175 | |
| | Governance, Ethics & Strategic Planning | 176–200 | |
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,SECTION I: CARE, SERVICES, AND SUPPORTS
Subsection A: Resident Rights & Quality of Life (Questions 1–20)
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 the most far-
reaching changes in nursing home regulation since Medicare and Medicaid
were created in 1965. It established requirements for resident assessments
(MDS), quality of care standards, and resident rights protections. The law
merged Medicaid and Medicare requirements and established the general
standard of promoting "maximum practicable functioning". OBRA '87 requires
nursing homes to provide specific services including 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.
Residents also have rights to privacy, dignity, and autonomy in their care
decisions.
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 (snack, music,
walk) 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
Core of Knowledge & CMS Compliance — 200 Questions &
Detailed Answers Based on NAB Domains | CMS Conditions
of Participation | Latest 2026/2027 Guidelines
| |Care, Services, and Supports | 1–55 | 45% |
| | Resident Rights & Quality of Life | 1–20 | |
| | Person-Centered Care & Care Planning | 21–35 | |
| | MDS Assessments & Clinical Services | 36–45 | |
| | Psychosocial Wellbeing & Abuse Prevention | 46–55 | |
| II | Operations| 56–110 | 28% |
| | Human Resources Management | 56–80 | |
| | Financial Management & Reimbursement | 81–100 | |
| | Regulatory Compliance & Survey Process | 101–110 | |
| III | Environment and Quality| 111–155 | 27% |
| | Physical Environment & Life Safety | 111–130 | |
| | Infection Prevention & Control | 131–145 | |
| | Quality Assurance & Performance Improvement (QAPI) | 146–155 | |
| IV | Leadership and Strategy** | 156–200 | 0%* |
| | Leadership & Organizational Management | 156–175 | |
| | Governance, Ethics & Strategic Planning | 176–200 | |
---
,SECTION I: CARE, SERVICES, AND SUPPORTS
Subsection A: Resident Rights & Quality of Life (Questions 1–20)
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 the most far-
reaching changes in nursing home regulation since Medicare and Medicaid
were created in 1965. It established requirements for resident assessments
(MDS), quality of care standards, and resident rights protections. The law
merged Medicaid and Medicare requirements and established the general
standard of promoting "maximum practicable functioning". OBRA '87 requires
nursing homes to provide specific services including 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.
Residents also have rights to privacy, dignity, and autonomy in their care
decisions.
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 (snack, music,
walk) 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
