FEDERAL NURSING HOME ADMINISTRATOR EXAM
GUIDE QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A resident with decision-making capacity says, ’I do not want my brother to receive my discharge
information.’ What should staff do?
A. Give the brother the information because relatives are always entitled to it.
B. Honor the resident’s privacy preference unless disclosure is otherwise permitted or required by law.
C. Post the discharge plan at the nurses’ station.
D. Refuse to discuss the plan with the resident.
Correct Answer: B. Honor the resident’s privacy preference unless disclosure is otherwise permitted or required
by law.
Explanation: Privacy rights continue during transitions. Information should be shared according to the resident’s
authorization and applicable law.
2. What is the purpose of personal protective equipment?
A. Identify which staff are licensed.
B. Prevent every infection regardless of use.
C. Replace vaccination and hand hygiene.
D. Create a barrier that reduces exposure of skin, clothing, eyes, nose, or mouth to infectious material when
exposure is anticipated.
Correct Answer: D. Create a barrier that reduces exposure of skin, clothing, eyes, nose, or mouth to infectious
material when exposure is anticipated.
Explanation: PPE is selected according to the anticipated exposure and is one part of a broader infection-control
system.
3. A staff member proposes a lap belt because a resident repeatedly tries to stand without assistance. What
should happen first?
A. Assess the reasons for standing and fall risk and consider less restrictive individualized interventions before
using a restraint.
B. Ask the family to sign a form that eliminates the need for assessment.
C. Use the belt whenever staffing is busy.
D. Apply the belt immediately because falls are possible.
Correct Answer: A. Assess the reasons for standing and fall risk and consider less restrictive individualized
interventions before using a restraint.
Explanation: Restraint decisions require careful assessment and least-restrictive alternatives. Convenience or
staffing needs do not justify restraint use.
4. What is break-even analysis used for?
A. To determine medication error significance.
B. To estimate the volume or revenue level at which total revenues equal total costs.
C. To measure infection rates.
D. To calculate only depreciation.
Correct Answer: B. To estimate the volume or revenue level at which total revenues equal total costs.
Explanation: Break-even analysis helps leaders understand the relationship among volume, revenue, fixed cost,
and variable cost.
5. A facility wants to reduce missed morning weights. What is a good small PDSA test?
A. Test a revised assignment and reminder process on one unit for a short period, measure completion, study
barriers, then adapt before spreading.
B. Stop collecting weights during the test.
C. Wait a year before reviewing results.
D. Change every unit at once without baseline data.
Correct Answer: A. Test a revised assignment and reminder process on one unit for a short period, measure
completion, study barriers, then adapt before spreading.
Explanation: Small tests reduce disruption and generate practical learning before broad implementation.
6. How often must the facility assess a resident at least quarterly?
A. No less often than once every 3 months.
,B. Every 6 months.
C. Only when the payer requests it.
D. Every week.
Correct Answer: A. No less often than once every 3 months.
Explanation: A quarterly assessment is required no less often than every three months.
7. A nurse newly hired from an outpatient clinic has never managed feeding tubes. Which assignment
approach is best?
A. Prohibit the nurse from any future training.
B. Assign the nurse to train others immediately.
C. Assume licensure alone proves competency for every task.
D. Verify and develop the nurse’s competency before assigning independent responsibility for feeding-tube care.
Correct Answer: D. Verify and develop the nurse’s competency before assigning independent responsibility for
feeding-tube care.
Explanation: Licensure establishes a professional credential, but facilities must also ensure competence for
assigned responsibilities.
8. What is the purpose of Appendix PP to the State Operations Manual?
A. Replace the Code of Federal Regulations.
B. Provide interpretive guidance and survey procedures for long-term care facility requirements.
C. Publish resident menus.
D. Set employee wage rates.
Correct Answer: B. Provide interpretive guidance and survey procedures for long-term care facility
requirements.
Explanation: Appendix PP helps surveyors and providers understand how CMS interprets and investigates
federal nursing facility requirements; the regulation itself remains controlling.
9. A resident receives an antipsychotic for behavioral symptoms of dementia with no documented
diagnosis, target symptom, or nonpharmacologic attempts. What should the administrator expect the
clinical team to do?
A. Remove all behavior documentation.
B. Continue the medication indefinitely because dementia is present.
C. Increase the dose until the resident is sleepy.
D. Reassess the indication, target symptoms, alternatives, risks, and regulatory requirements for unnecessary
drugs and psychotropic use.
Correct Answer: D. Reassess the indication, target symptoms, alternatives, risks, and regulatory requirements
for unnecessary drugs and psychotropic use.
Explanation: Psychotropic therapy requires a valid clinical rationale, monitoring, and appropriate efforts to use
nonpharmacologic approaches and dose reduction when indicated.
10. What is the purpose of business continuity planning?
A. Focus only on marketing after a disaster.
B. Apply only to natural disasters.
C. Maintain or restore essential operations when events disrupt normal systems, facilities, vendors, staffing, or
technology.
D. Replace the emergency preparedness program entirely.
Correct Answer: C. Maintain or restore essential operations when events disrupt normal systems, facilities,
vendors, staffing, or technology.
Explanation: Business continuity complements emergency planning by identifying essential functions,
dependencies, backups, and recovery priorities.
11. A proposed two-resident room has 150 square feet of usable resident area. Based on the usual
80-square-feet-per-resident federal standard, what is the main concern?
A. The room exceeds the standard by 70 square feet.
B. The room is 10 square feet short of the usual 160-square-foot minimum for two residents.
C. Square footage is unrelated to room occupancy.
D. The room needs only 100 square feet total.
Correct Answer: B. The room is 10 square feet short of the usual 160-square-foot minimum for two residents.
,Explanation: Two residents at 80 square feet each require 160 square feet. A 150-square-foot room would
generally be below that standard absent an applicable exception or waiver.
12. What is the central idea of person-centered care in federal LTC regulations?
A. Staff efficiency is the primary determinant of daily schedules.
B. Family preferences automatically replace resident preferences at admission.
C. The medical director makes all decisions that affect resident routines.
D. The resident is the locus of control and is supported in making choices about daily life.
Correct Answer: D. The resident is the locus of control and is supported in making choices about daily life.
Explanation: Person-centered care focuses on the resident as the locus of control. It combines individualized
needs with meaningful choice and participation.
13. A resident has uncontrolled draining wound secretions. What should staff determine in addition to
standard precautions?
A. Whether the resident should receive no visitors.
B. Whether documentation can replace precautions.
C. Whether additional transmission-based or enhanced barrier measures are indicated based on the organism,
drainage, and care activities.
D. Whether all PPE can be discontinued.
Correct Answer: C. Whether additional transmission-based or enhanced barrier measures are indicated based on
the organism, drainage, and care activities.
Explanation: The type and intensity of precautions depend on the route of transmission, containment of body
fluids, organism, and resident-care activities.
14. What is the purpose of a therapeutic diet?
A. To replace physician or practitioner orders.
B. To modify food or nutrients to support a resident’s diagnosed condition or treatment needs while maintaining
adequate intake and acceptability.
C. To reduce kitchen workload.
D. To make all residents eat the same foods.
Correct Answer: B. To modify food or nutrients to support a resident’s diagnosed condition or treatment needs
while maintaining adequate intake and acceptability.
Explanation: Therapeutic diets are individualized for clinical needs and should be balanced with resident
preferences and nutritional adequacy.
15. Surveyors find that staff knowingly continue giving a contraindicated medication that has repeatedly
caused severe hypoglycemia requiring emergency treatment. What survey concern may be most serious?
A. The facts may support immediate-jeopardy analysis because continued noncompliance creates a likelihood of
serious harm.
B. The issue is automatically minor because medication was ordered.
C. The finding relates only to billing.
D. Surveyors can consider only actual death.
Correct Answer: A. The facts may support immediate-jeopardy analysis because continued noncompliance
creates a likelihood of serious harm.
Explanation: Immediate jeopardy can be based on serious harm or the likelihood of serious harm. Surveyors
evaluate severity, scope, and the facility’s response.
16. What is payer mix?
A. The mix of employee job titles.
B. The proportion of meals served by diet type.
C. The percentage of rooms with two beds.
D. The proportion of residents or revenue associated with different payment sources such as Medicare, Medicaid,
managed care, and private pay.
Correct Answer: D. The proportion of residents or revenue associated with different payment sources such as
Medicare, Medicaid, managed care, and private pay.
Explanation: Payer mix describes how payment sources are distributed. It affects revenue, contracting, cash
flow, and financial planning.
17. The team repeatedly updates care plans, but direct-care staff report they cannot easily access the
current version. What system problem is most apparent?
, A. Care-plan communication and accessibility are inadequate even if the document itself is technically complete.
B. The solution is to stop revising plans.
C. Only direct-care staff should write the entire plan.
D. The facility has too many residents with preferences.
Correct Answer: A. Care-plan communication and accessibility are inadequate even if the document itself is
technically complete.
Explanation: A technically complete plan cannot guide care if responsible staff cannot access or understand it.
Implementation systems matter as much as documentation.
18. Why is emergency power important in a nursing facility?
A. It supports essential systems and services when normal electrical power is interrupted.
B. It powers decorative lighting only.
C. It is needed only during winter.
D. It replaces all evacuation planning.
Correct Answer: A. It supports essential systems and services when normal electrical power is interrupted.
Explanation: Loss of power can affect life-safety systems, oxygen equipment, refrigeration, lighting,
commu-nications, and other essential operations.
19. A resident is transferred to a hospital after sudden respiratory distress. Which action best protects
continuity of care?
A. Delete the current medication list because the hospital will start over.
B. Send only the resident’s insurance card.
C. Wait until the next business day to share clinical information.
D. Send or make available current clinical information and medication details to the receiving provider as
promptly as possible.
Correct Answer: D. Send or make available current clinical information and medication details to the receiving
provider as promptly as possible.
Explanation: Timely transfer information reduces medication errors and gaps in treatment during an acute
transition.
20. What is strategic planning?
A. A list of current residents.
B. The daily assignment of nursing assistants.
C. A medication reconciliation tool.
D. A structured process for defining longer-term goals, priorities, resources, and actions in light of the
organization’s mission and environment.
Correct Answer: D. A structured process for defining longer-term goals, priorities, resources, and actions in light
of the organization’s mission and environment.
Explanation: Strategic planning connects mission, market and regulatory conditions, resources, risks, and
measurable priorities over time.
21. One unit reports zero falls for three months, but incident reports show several falls occurred. What
should the QAPI team conclude?
A. The unit should receive a quality award.
B. Incident reports should be discarded.
C. Falls in incident reports do not count as events.
D. The fall measure or reporting process is incomplete and must be reconciled before comparing unit
performance.
Correct Answer: D. The fall measure or reporting process is incomplete and must be reconciled before
comparing unit performance.
Explanation: Conflicting data sources signal a measurement problem. Improvement work should begin by
reconciling the data and reporting process.
22. What is the role of the medical director in a nursing facility?
A. To replace the attending physician for every resident.
B. To help implement resident-care policies and coordinate medical care in the facility.
C. To manage payroll and vendor invoices only.
D. To supervise housekeeping schedules exclusively.
Correct Answer: B. To help implement resident-care policies and coordinate medical care in the facility.
GUIDE QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A resident with decision-making capacity says, ’I do not want my brother to receive my discharge
information.’ What should staff do?
A. Give the brother the information because relatives are always entitled to it.
B. Honor the resident’s privacy preference unless disclosure is otherwise permitted or required by law.
C. Post the discharge plan at the nurses’ station.
D. Refuse to discuss the plan with the resident.
Correct Answer: B. Honor the resident’s privacy preference unless disclosure is otherwise permitted or required
by law.
Explanation: Privacy rights continue during transitions. Information should be shared according to the resident’s
authorization and applicable law.
2. What is the purpose of personal protective equipment?
A. Identify which staff are licensed.
B. Prevent every infection regardless of use.
C. Replace vaccination and hand hygiene.
D. Create a barrier that reduces exposure of skin, clothing, eyes, nose, or mouth to infectious material when
exposure is anticipated.
Correct Answer: D. Create a barrier that reduces exposure of skin, clothing, eyes, nose, or mouth to infectious
material when exposure is anticipated.
Explanation: PPE is selected according to the anticipated exposure and is one part of a broader infection-control
system.
3. A staff member proposes a lap belt because a resident repeatedly tries to stand without assistance. What
should happen first?
A. Assess the reasons for standing and fall risk and consider less restrictive individualized interventions before
using a restraint.
B. Ask the family to sign a form that eliminates the need for assessment.
C. Use the belt whenever staffing is busy.
D. Apply the belt immediately because falls are possible.
Correct Answer: A. Assess the reasons for standing and fall risk and consider less restrictive individualized
interventions before using a restraint.
Explanation: Restraint decisions require careful assessment and least-restrictive alternatives. Convenience or
staffing needs do not justify restraint use.
4. What is break-even analysis used for?
A. To determine medication error significance.
B. To estimate the volume or revenue level at which total revenues equal total costs.
C. To measure infection rates.
D. To calculate only depreciation.
Correct Answer: B. To estimate the volume or revenue level at which total revenues equal total costs.
Explanation: Break-even analysis helps leaders understand the relationship among volume, revenue, fixed cost,
and variable cost.
5. A facility wants to reduce missed morning weights. What is a good small PDSA test?
A. Test a revised assignment and reminder process on one unit for a short period, measure completion, study
barriers, then adapt before spreading.
B. Stop collecting weights during the test.
C. Wait a year before reviewing results.
D. Change every unit at once without baseline data.
Correct Answer: A. Test a revised assignment and reminder process on one unit for a short period, measure
completion, study barriers, then adapt before spreading.
Explanation: Small tests reduce disruption and generate practical learning before broad implementation.
6. How often must the facility assess a resident at least quarterly?
A. No less often than once every 3 months.
,B. Every 6 months.
C. Only when the payer requests it.
D. Every week.
Correct Answer: A. No less often than once every 3 months.
Explanation: A quarterly assessment is required no less often than every three months.
7. A nurse newly hired from an outpatient clinic has never managed feeding tubes. Which assignment
approach is best?
A. Prohibit the nurse from any future training.
B. Assign the nurse to train others immediately.
C. Assume licensure alone proves competency for every task.
D. Verify and develop the nurse’s competency before assigning independent responsibility for feeding-tube care.
Correct Answer: D. Verify and develop the nurse’s competency before assigning independent responsibility for
feeding-tube care.
Explanation: Licensure establishes a professional credential, but facilities must also ensure competence for
assigned responsibilities.
8. What is the purpose of Appendix PP to the State Operations Manual?
A. Replace the Code of Federal Regulations.
B. Provide interpretive guidance and survey procedures for long-term care facility requirements.
C. Publish resident menus.
D. Set employee wage rates.
Correct Answer: B. Provide interpretive guidance and survey procedures for long-term care facility
requirements.
Explanation: Appendix PP helps surveyors and providers understand how CMS interprets and investigates
federal nursing facility requirements; the regulation itself remains controlling.
9. A resident receives an antipsychotic for behavioral symptoms of dementia with no documented
diagnosis, target symptom, or nonpharmacologic attempts. What should the administrator expect the
clinical team to do?
A. Remove all behavior documentation.
B. Continue the medication indefinitely because dementia is present.
C. Increase the dose until the resident is sleepy.
D. Reassess the indication, target symptoms, alternatives, risks, and regulatory requirements for unnecessary
drugs and psychotropic use.
Correct Answer: D. Reassess the indication, target symptoms, alternatives, risks, and regulatory requirements
for unnecessary drugs and psychotropic use.
Explanation: Psychotropic therapy requires a valid clinical rationale, monitoring, and appropriate efforts to use
nonpharmacologic approaches and dose reduction when indicated.
10. What is the purpose of business continuity planning?
A. Focus only on marketing after a disaster.
B. Apply only to natural disasters.
C. Maintain or restore essential operations when events disrupt normal systems, facilities, vendors, staffing, or
technology.
D. Replace the emergency preparedness program entirely.
Correct Answer: C. Maintain or restore essential operations when events disrupt normal systems, facilities,
vendors, staffing, or technology.
Explanation: Business continuity complements emergency planning by identifying essential functions,
dependencies, backups, and recovery priorities.
11. A proposed two-resident room has 150 square feet of usable resident area. Based on the usual
80-square-feet-per-resident federal standard, what is the main concern?
A. The room exceeds the standard by 70 square feet.
B. The room is 10 square feet short of the usual 160-square-foot minimum for two residents.
C. Square footage is unrelated to room occupancy.
D. The room needs only 100 square feet total.
Correct Answer: B. The room is 10 square feet short of the usual 160-square-foot minimum for two residents.
,Explanation: Two residents at 80 square feet each require 160 square feet. A 150-square-foot room would
generally be below that standard absent an applicable exception or waiver.
12. What is the central idea of person-centered care in federal LTC regulations?
A. Staff efficiency is the primary determinant of daily schedules.
B. Family preferences automatically replace resident preferences at admission.
C. The medical director makes all decisions that affect resident routines.
D. The resident is the locus of control and is supported in making choices about daily life.
Correct Answer: D. The resident is the locus of control and is supported in making choices about daily life.
Explanation: Person-centered care focuses on the resident as the locus of control. It combines individualized
needs with meaningful choice and participation.
13. A resident has uncontrolled draining wound secretions. What should staff determine in addition to
standard precautions?
A. Whether the resident should receive no visitors.
B. Whether documentation can replace precautions.
C. Whether additional transmission-based or enhanced barrier measures are indicated based on the organism,
drainage, and care activities.
D. Whether all PPE can be discontinued.
Correct Answer: C. Whether additional transmission-based or enhanced barrier measures are indicated based on
the organism, drainage, and care activities.
Explanation: The type and intensity of precautions depend on the route of transmission, containment of body
fluids, organism, and resident-care activities.
14. What is the purpose of a therapeutic diet?
A. To replace physician or practitioner orders.
B. To modify food or nutrients to support a resident’s diagnosed condition or treatment needs while maintaining
adequate intake and acceptability.
C. To reduce kitchen workload.
D. To make all residents eat the same foods.
Correct Answer: B. To modify food or nutrients to support a resident’s diagnosed condition or treatment needs
while maintaining adequate intake and acceptability.
Explanation: Therapeutic diets are individualized for clinical needs and should be balanced with resident
preferences and nutritional adequacy.
15. Surveyors find that staff knowingly continue giving a contraindicated medication that has repeatedly
caused severe hypoglycemia requiring emergency treatment. What survey concern may be most serious?
A. The facts may support immediate-jeopardy analysis because continued noncompliance creates a likelihood of
serious harm.
B. The issue is automatically minor because medication was ordered.
C. The finding relates only to billing.
D. Surveyors can consider only actual death.
Correct Answer: A. The facts may support immediate-jeopardy analysis because continued noncompliance
creates a likelihood of serious harm.
Explanation: Immediate jeopardy can be based on serious harm or the likelihood of serious harm. Surveyors
evaluate severity, scope, and the facility’s response.
16. What is payer mix?
A. The mix of employee job titles.
B. The proportion of meals served by diet type.
C. The percentage of rooms with two beds.
D. The proportion of residents or revenue associated with different payment sources such as Medicare, Medicaid,
managed care, and private pay.
Correct Answer: D. The proportion of residents or revenue associated with different payment sources such as
Medicare, Medicaid, managed care, and private pay.
Explanation: Payer mix describes how payment sources are distributed. It affects revenue, contracting, cash
flow, and financial planning.
17. The team repeatedly updates care plans, but direct-care staff report they cannot easily access the
current version. What system problem is most apparent?
, A. Care-plan communication and accessibility are inadequate even if the document itself is technically complete.
B. The solution is to stop revising plans.
C. Only direct-care staff should write the entire plan.
D. The facility has too many residents with preferences.
Correct Answer: A. Care-plan communication and accessibility are inadequate even if the document itself is
technically complete.
Explanation: A technically complete plan cannot guide care if responsible staff cannot access or understand it.
Implementation systems matter as much as documentation.
18. Why is emergency power important in a nursing facility?
A. It supports essential systems and services when normal electrical power is interrupted.
B. It powers decorative lighting only.
C. It is needed only during winter.
D. It replaces all evacuation planning.
Correct Answer: A. It supports essential systems and services when normal electrical power is interrupted.
Explanation: Loss of power can affect life-safety systems, oxygen equipment, refrigeration, lighting,
commu-nications, and other essential operations.
19. A resident is transferred to a hospital after sudden respiratory distress. Which action best protects
continuity of care?
A. Delete the current medication list because the hospital will start over.
B. Send only the resident’s insurance card.
C. Wait until the next business day to share clinical information.
D. Send or make available current clinical information and medication details to the receiving provider as
promptly as possible.
Correct Answer: D. Send or make available current clinical information and medication details to the receiving
provider as promptly as possible.
Explanation: Timely transfer information reduces medication errors and gaps in treatment during an acute
transition.
20. What is strategic planning?
A. A list of current residents.
B. The daily assignment of nursing assistants.
C. A medication reconciliation tool.
D. A structured process for defining longer-term goals, priorities, resources, and actions in light of the
organization’s mission and environment.
Correct Answer: D. A structured process for defining longer-term goals, priorities, resources, and actions in light
of the organization’s mission and environment.
Explanation: Strategic planning connects mission, market and regulatory conditions, resources, risks, and
measurable priorities over time.
21. One unit reports zero falls for three months, but incident reports show several falls occurred. What
should the QAPI team conclude?
A. The unit should receive a quality award.
B. Incident reports should be discarded.
C. Falls in incident reports do not count as events.
D. The fall measure or reporting process is incomplete and must be reconciled before comparing unit
performance.
Correct Answer: D. The fall measure or reporting process is incomplete and must be reconciled before
comparing unit performance.
Explanation: Conflicting data sources signal a measurement problem. Improvement work should begin by
reconciling the data and reporting process.
22. What is the role of the medical director in a nursing facility?
A. To replace the attending physician for every resident.
B. To help implement resident-care policies and coordinate medical care in the facility.
C. To manage payroll and vendor invoices only.
D. To supervise housekeeping schedules exclusively.
Correct Answer: B. To help implement resident-care policies and coordinate medical care in the facility.
