NAB NURSING HOME ADMINISTRATOR
EXAM-CORE KNOWLEDGE | ALL
QUESTIONS AND SOLUTIONS
(RATIONALES) 2026 | EXAM PREP
1. A nursing home administrator notices that several residents have experienced falls
during evening shifts. Incident reports indicate that most falls occur while residents
attempt to reach the bathroom without assistance. What should the administrator do
FIRST?
A. Restrict all residents from walking independently during evening hours.
B. Review incident trends, assess contributing factors, and implement targeted fall-prevention
interventions.
C. Discipline the evening nursing staff responsible for the affected residents.
D. Require all residents to remain in bed after dinner.
Answer: B
Rationale: Reviewing incident data and assessing contributing factors helps identify
underlying risks and supports targeted interventions. Blanket restrictions can unnecessarily
limit resident independence, while disciplinary action without investigation does not address
systemic causes.
2. Under person-centered care principles, which action best demonstrates respect for a
resident's autonomy?
A. Allowing residents to make informed choices about their daily routines whenever safely
possible.
B. Requiring all residents to follow identical meal and bathing schedules.
C. Allowing family members to make every decision regardless of the resident's capacity.
D. Prioritizing staff convenience when developing individual care plans.
Answer: A
Page 1 of 81
,Rationale: Person-centered care recognizes residents' rights to participate in decisions
affecting their lives. Individual preferences should be respected while maintaining
appropriate safety measures and complying with applicable requirements.
3. A nursing home administrator discovers that a staff member documented a medication
as administered even though the medication was not given. What is the MOST appropriate
initial response?
A. Delete the entry and replace it with a corrected record without documenting the change.
B. Wait until the next scheduled medication audit before taking action.
C. Notify every resident's family immediately, regardless of whether they are affected.
D. Ensure the resident is assessed, verify the medication discrepancy, and initiate the required
reporting and investigation procedures.
Answer: D
Rationale: The administrator must prioritize resident safety, determine whether the omission
has caused harm, and ensure appropriate clinical follow-up. Documentation must be
corrected transparently according to policy, and reporting, investigation, and disciplinary
decisions should follow applicable requirements.
4. Which financial statement provides the clearest picture of a nursing home's financial
position at a specific point in time?
A. Statement of cash flows.
B. Operating budget.
C. Balance sheet.
D. Income statement.
Answer: C
Rationale: A balance sheet reports assets, liabilities, and equity or net assets at a particular
date. An income statement summarizes financial performance over a period, while a cash
flow statement tracks cash inflows and outflows.
5. A facility's occupancy rate has declined steadily for three months, while fixed operating
costs remain unchanged. Which action would BEST help management understand the
financial implications?
Page 2 of 81
,A. Calculate the financial effect of lower occupancy, review admission trends, and develop a
corrective operating plan.
B. Immediately reduce all staffing levels by the same percentage as the occupancy decline.
C. Increase resident charges without reviewing contractual or regulatory requirements.
D. Eliminate preventive maintenance until occupancy improves.
Answer: A
Rationale: Declining occupancy can reduce revenue while fixed expenses continue.
Management should analyze contribution margins, referral patterns, staffing needs, and
operating costs before making targeted adjustments that preserve care quality and
regulatory compliance.
6. Which document generally establishes the resident-specific goals, interventions, and
services needed to address assessed care needs?
A. Facility marketing plan.
B. Individualized resident care plan.
C. Annual capital expenditure report.
D. Employee performance appraisal.
Answer: B
Rationale: An individualized care plan translates assessment findings into resident-specific
goals, interventions, and services. It should reflect the resident's needs, preferences, and
applicable care-planning requirements.
7. A resident with decision-making capacity refuses a prescribed treatment despite the
nursing team's concerns. What should the administrator support?
A. Allowing staff to administer the treatment without informing the resident.
B. Transferring the resident automatically to another facility.
C. Asking the resident's family to override the refusal.
D. Ensuring the resident receives understandable information about risks and alternatives,
documenting the decision, and respecting the informed refusal.
Answer: D
Page 3 of 81
, Rationale: A resident with decision-making capacity generally has the right to refuse
treatment. The care team should explain the potential consequences, explore alternatives,
document the discussion, and follow applicable clinical and legal requirements without
coercion.
8. Which management practice is MOST effective for reducing preventable workplace
injuries in a nursing home?
A. Providing safety training only after an employee is injured.
B. Assigning all physically demanding tasks to experienced employees.
C. Combining hazard assessments, staff training, appropriate equipment, and incident review.
D. Discouraging employees from reporting minor injuries.
Answer: C
Rationale: An effective occupational safety program identifies hazards before injuries occur
and uses training, appropriate equipment, reporting, and corrective actions to reduce risk.
Suppressing reports prevents the facility from recognizing recurring problems.
9. A nursing home receives an allegation that a nursing assistant verbally abused a
resident. Which response is MOST appropriate?
A. Protect the resident, initiate the required reporting and investigation process, and take
appropriate interim safeguards.
B. Wait for conclusive proof before taking any protective action.
C. Ask the accused employee to investigate the allegation independently.
D. Resolve the matter informally without recording the complaint.
Answer: A
Rationale: Allegations of abuse require prompt protective action and handling under
applicable reporting deadlines and investigative procedures. The facility should safeguard the
resident, preserve relevant evidence, and avoid prejudging the investigation.
10. What is the PRIMARY purpose of a nursing home's quality assurance and
performance improvement program?
A. To eliminate the need for external inspections.
Page 4 of 81
EXAM-CORE KNOWLEDGE | ALL
QUESTIONS AND SOLUTIONS
(RATIONALES) 2026 | EXAM PREP
1. A nursing home administrator notices that several residents have experienced falls
during evening shifts. Incident reports indicate that most falls occur while residents
attempt to reach the bathroom without assistance. What should the administrator do
FIRST?
A. Restrict all residents from walking independently during evening hours.
B. Review incident trends, assess contributing factors, and implement targeted fall-prevention
interventions.
C. Discipline the evening nursing staff responsible for the affected residents.
D. Require all residents to remain in bed after dinner.
Answer: B
Rationale: Reviewing incident data and assessing contributing factors helps identify
underlying risks and supports targeted interventions. Blanket restrictions can unnecessarily
limit resident independence, while disciplinary action without investigation does not address
systemic causes.
2. Under person-centered care principles, which action best demonstrates respect for a
resident's autonomy?
A. Allowing residents to make informed choices about their daily routines whenever safely
possible.
B. Requiring all residents to follow identical meal and bathing schedules.
C. Allowing family members to make every decision regardless of the resident's capacity.
D. Prioritizing staff convenience when developing individual care plans.
Answer: A
Page 1 of 81
,Rationale: Person-centered care recognizes residents' rights to participate in decisions
affecting their lives. Individual preferences should be respected while maintaining
appropriate safety measures and complying with applicable requirements.
3. A nursing home administrator discovers that a staff member documented a medication
as administered even though the medication was not given. What is the MOST appropriate
initial response?
A. Delete the entry and replace it with a corrected record without documenting the change.
B. Wait until the next scheduled medication audit before taking action.
C. Notify every resident's family immediately, regardless of whether they are affected.
D. Ensure the resident is assessed, verify the medication discrepancy, and initiate the required
reporting and investigation procedures.
Answer: D
Rationale: The administrator must prioritize resident safety, determine whether the omission
has caused harm, and ensure appropriate clinical follow-up. Documentation must be
corrected transparently according to policy, and reporting, investigation, and disciplinary
decisions should follow applicable requirements.
4. Which financial statement provides the clearest picture of a nursing home's financial
position at a specific point in time?
A. Statement of cash flows.
B. Operating budget.
C. Balance sheet.
D. Income statement.
Answer: C
Rationale: A balance sheet reports assets, liabilities, and equity or net assets at a particular
date. An income statement summarizes financial performance over a period, while a cash
flow statement tracks cash inflows and outflows.
5. A facility's occupancy rate has declined steadily for three months, while fixed operating
costs remain unchanged. Which action would BEST help management understand the
financial implications?
Page 2 of 81
,A. Calculate the financial effect of lower occupancy, review admission trends, and develop a
corrective operating plan.
B. Immediately reduce all staffing levels by the same percentage as the occupancy decline.
C. Increase resident charges without reviewing contractual or regulatory requirements.
D. Eliminate preventive maintenance until occupancy improves.
Answer: A
Rationale: Declining occupancy can reduce revenue while fixed expenses continue.
Management should analyze contribution margins, referral patterns, staffing needs, and
operating costs before making targeted adjustments that preserve care quality and
regulatory compliance.
6. Which document generally establishes the resident-specific goals, interventions, and
services needed to address assessed care needs?
A. Facility marketing plan.
B. Individualized resident care plan.
C. Annual capital expenditure report.
D. Employee performance appraisal.
Answer: B
Rationale: An individualized care plan translates assessment findings into resident-specific
goals, interventions, and services. It should reflect the resident's needs, preferences, and
applicable care-planning requirements.
7. A resident with decision-making capacity refuses a prescribed treatment despite the
nursing team's concerns. What should the administrator support?
A. Allowing staff to administer the treatment without informing the resident.
B. Transferring the resident automatically to another facility.
C. Asking the resident's family to override the refusal.
D. Ensuring the resident receives understandable information about risks and alternatives,
documenting the decision, and respecting the informed refusal.
Answer: D
Page 3 of 81
, Rationale: A resident with decision-making capacity generally has the right to refuse
treatment. The care team should explain the potential consequences, explore alternatives,
document the discussion, and follow applicable clinical and legal requirements without
coercion.
8. Which management practice is MOST effective for reducing preventable workplace
injuries in a nursing home?
A. Providing safety training only after an employee is injured.
B. Assigning all physically demanding tasks to experienced employees.
C. Combining hazard assessments, staff training, appropriate equipment, and incident review.
D. Discouraging employees from reporting minor injuries.
Answer: C
Rationale: An effective occupational safety program identifies hazards before injuries occur
and uses training, appropriate equipment, reporting, and corrective actions to reduce risk.
Suppressing reports prevents the facility from recognizing recurring problems.
9. A nursing home receives an allegation that a nursing assistant verbally abused a
resident. Which response is MOST appropriate?
A. Protect the resident, initiate the required reporting and investigation process, and take
appropriate interim safeguards.
B. Wait for conclusive proof before taking any protective action.
C. Ask the accused employee to investigate the allegation independently.
D. Resolve the matter informally without recording the complaint.
Answer: A
Rationale: Allegations of abuse require prompt protective action and handling under
applicable reporting deadlines and investigative procedures. The facility should safeguard the
resident, preserve relevant evidence, and avoid prejudging the investigation.
10. What is the PRIMARY purpose of a nursing home's quality assurance and
performance improvement program?
A. To eliminate the need for external inspections.
Page 4 of 81
