FEDERAL NURSING HOME ADMINISTRATOR EXAM 2026/2027 EDITION
VERIFIED WITH CORRECT ANSWERS | 190+ QUESTIONS & ANSWERS |
GRADED A+ | 100% VERIFIED
Federal Nursing Home Administrator (NHA) Licensure Examination | Core Domains: OBRA Regulations & Resident Rights, Leadership &
Strategic Management, Financial Management & Accounting Principles, Human Resources Management, Environmental Safety & Life Safety
Code (LSC), Resident Care & Quality Assurance, Legal & Ethical Responsibilities, Infection Control, Medicare/Medicaid Reimbursement, and
Emergency Preparedness | NAB Exam-Aligned Format | Federal Certification Focus
Table of Contents
• Domain 1: Resident Care Management (Questions 1-48) • Domain 2: Personnel/Human Resources (Questions 49-86) • Domain 3:
Financial Management (Questions 87-124) • Domain 4: Environmental Management (Questions 125-152) • Domain 5: Leadership and
Governance (Questions 153-190)
Exam Structure
The Federal Nursing Home Administrator Licensure Examination is a comprehensive assessment consisting of:
• 190+ multiple-choice questions with verified correct answers
• Five major content domains:
- Resident Care Management (approximately 25% of exam)
- Personnel/Human Resources (approximately 20% of exam)
- Financial Management (approximately 20% of exam)
- Environmental Management (approximately 15% of exam)
- Leadership and Governance (approximately 20% of exam)
• Clinical case scenarios and administrative decision-making items
• Regulatory compliance questions based on OBRA '87, OSHA, and CMS guidelines
• Financial management and accounting principle applications
• Life Safety Code (LSC) and environmental safety protocols
• Resident rights and ethical decision-making scenarios
Introduction
This Federal Nursing Home Administrator Exam preparation document for the 2026/2027 edition reflects the official NAB (National Association
of Long Term Care Administrator Boards) examination requirements for nursing home administration licensure. The comprehensive examination
evaluates understanding of core competencies required for licensed nursing home administrators including federal regulations under OBRA '87,
resident rights and quality of life provisions, leadership and strategic planning, financial management including GAAP accounting principles and
Medicare/Medicaid reimbursement, human resources management and labor relations, environmental safety and Life Safety Code compliance,
infection control protocols, emergency preparedness, and legal/ethical responsibilities in long-term care settings.
The test bank emphasizes practical application of federal regulations, administrative decision-making, and clinical judgment—mirroring the actual
NAB exam approach of testing real-world knowledge rather than theoretical concepts. Key topic areas include OBRA regulatory requirements,
quality assurance and performance improvement (QAPI), MDS 3.0 and resident assessment, payor mix and case mix management, Life Safety
Code inspection processes, infection control committees, resident fund management, medical records laws, and appropriate delegation and
supervision.
Each question includes the correct answer in bold green followed by a detailed rationale that reinforces statutory requirements under OBRA '87,
CMS guidelines, OSHA standards, and best practices in long-term care administration essential for NAB exam success and professional practice.
,Answer Format
All questions must be presented in bold text for clear distinction and readability.
All correct answers must be presented in bold and green, followed by clearly defined, legally focused rationales that reinforce federal nursing
home regulations, administrative best practices, and resident-centered care principles.
Domain 1: Resident Care Management (Questions 1-48)
Question 1: Under OBRA '87, how often must a comprehensive resident assessment be completed?
A) Within 7 days of admission
B) Within 14 days of admission
C) Within 30 days of admission
D) Within 60 days of admission
Correct Answer: B) Within 14 days of admission
Rationale: OBRA '87 requires a comprehensive resident assessment using the MDS (Minimum Data Set) within 14 days of admission. A preliminary
assessment must be completed within 72 hours. Annual reassessments are required, plus significant change assessments when condition changes.
Question 2: What is the primary purpose of the Resident Assessment Instrument (RAI)?
A) Billing and reimbursement only
B) Develop individualized care plans based on resident needs
C) Staff scheduling
D) Facility inspection preparation
Correct Answer: B) Develop individualized care plans based on resident needs
Rationale: The RAI (including MDS 3.0) is designed to comprehensively assess resident needs and develop individualized care plans. While it's used
for reimbursement (RUGs/PDPM), its primary purpose is resident-centered care planning and quality improvement.
Question 3: Under federal regulations, residents have the right to:
A) Choose their roommates only
B) Manage their personal funds
C) Both A and B
D) Neither A nor B
Correct Answer: C) Both A and B
, Rationale: OBRA '87 Resident Bill of Rights includes right to choose roommates (when feasible) and right to manage personal funds. Facilities must
provide financial services for residents who request assistance. These are fundamental resident rights under federal regulations.
Question 4: How often must fire drills be conducted in a nursing home?
A) Monthly on each shift
B) Quarterly on each shift
C) Semi-annually
D) Annually
Correct Answer: B) Quarterly on each shift
Rationale: Life Safety Code requires fire drills quarterly on each shift (day, evening, night). This ensures all staff are trained in emergency procedures.
Documentation of drills must be maintained. Some states may have more frequent requirements.
Question 5: What is the minimum staffing requirement for licensed nurses per day?
A) 4 consecutive hours
B) 8 consecutive hours
C) 12 consecutive hours
D) 24 consecutive hours
Correct Answer: B) 8 consecutive hours
Rationale: OBRA '87 requires licensed nurse (RN or LPN/LVN) coverage for at least 8 consecutive hours per day, 7 days per week. RN must be
present for at least 8 hours per day. Director of Nursing must be RN. Some states have more stringent requirements.
Question 6: What does QAPI stand for in long-term care?
A) Quality Assessment and Performance Improvement
B) Quality Assurance and Patient Inspection
C) Quality Assessment and Program Implementation
D) Quality Assurance and Performance Index
Correct Answer: A) Quality Assessment and Performance Improvement
Rationale: QAPI (Quality Assessment and Performance Improvement) is the CMS-mandated quality program combining QA and PI approaches.
Facilities must have QAPI committee, conduct ongoing monitoring, and implement performance improvement projects. Required under ACA 2010.
Question 7: How long must medical records be retained after a resident is discharged?
A) 3 years
, B) 5 years
C) 7 years
D) As required by state law
Correct Answer: D) As required by state law
Rationale: Federal regulations require medical records be retained for period required by state law. Most states require 5-10 years after discharge or
death. Some require longer for minors. Check specific state requirements. Records must be accessible for survey process.
Question 8: What is the primary purpose of a care plan conference?
A) Billing review
B) Involve resident/family in care planning
C) Staff evaluation
D) Survey preparation
Correct Answer: B) Involve resident/family in care planning
Rationale: Care plan conferences must involve resident and/or family to ensure resident-centered care. Required within 7 days after completion of
comprehensive assessment. Resident participation is a federal right. Plans must be reviewed quarterly or when condition changes.
Question 9: Under Medicare Part A, what is the maximum benefit period for skilled nursing facility care?
A) 60 days
B) 90 days
C) 100 days
D) 365 days
Correct Answer: C) 100 days
Rationale: Medicare Part A covers up to 100 days per benefit period in SNF. Days 1-20: 100% covered. Days 21-100: coinsurance required. Must
meet skilled need criteria. After 100 days, resident may qualify for Medicaid or private pay. Benefit period resets after 60 days without skilled care.
Question 10: What is the primary function of the Infection Control Committee?
A) Staff discipline
B) Develop and monitor infection prevention programs
C) Budget management
D) Resident admissions
Correct Answer: B) Develop and monitor infection prevention programs
VERIFIED WITH CORRECT ANSWERS | 190+ QUESTIONS & ANSWERS |
GRADED A+ | 100% VERIFIED
Federal Nursing Home Administrator (NHA) Licensure Examination | Core Domains: OBRA Regulations & Resident Rights, Leadership &
Strategic Management, Financial Management & Accounting Principles, Human Resources Management, Environmental Safety & Life Safety
Code (LSC), Resident Care & Quality Assurance, Legal & Ethical Responsibilities, Infection Control, Medicare/Medicaid Reimbursement, and
Emergency Preparedness | NAB Exam-Aligned Format | Federal Certification Focus
Table of Contents
• Domain 1: Resident Care Management (Questions 1-48) • Domain 2: Personnel/Human Resources (Questions 49-86) • Domain 3:
Financial Management (Questions 87-124) • Domain 4: Environmental Management (Questions 125-152) • Domain 5: Leadership and
Governance (Questions 153-190)
Exam Structure
The Federal Nursing Home Administrator Licensure Examination is a comprehensive assessment consisting of:
• 190+ multiple-choice questions with verified correct answers
• Five major content domains:
- Resident Care Management (approximately 25% of exam)
- Personnel/Human Resources (approximately 20% of exam)
- Financial Management (approximately 20% of exam)
- Environmental Management (approximately 15% of exam)
- Leadership and Governance (approximately 20% of exam)
• Clinical case scenarios and administrative decision-making items
• Regulatory compliance questions based on OBRA '87, OSHA, and CMS guidelines
• Financial management and accounting principle applications
• Life Safety Code (LSC) and environmental safety protocols
• Resident rights and ethical decision-making scenarios
Introduction
This Federal Nursing Home Administrator Exam preparation document for the 2026/2027 edition reflects the official NAB (National Association
of Long Term Care Administrator Boards) examination requirements for nursing home administration licensure. The comprehensive examination
evaluates understanding of core competencies required for licensed nursing home administrators including federal regulations under OBRA '87,
resident rights and quality of life provisions, leadership and strategic planning, financial management including GAAP accounting principles and
Medicare/Medicaid reimbursement, human resources management and labor relations, environmental safety and Life Safety Code compliance,
infection control protocols, emergency preparedness, and legal/ethical responsibilities in long-term care settings.
The test bank emphasizes practical application of federal regulations, administrative decision-making, and clinical judgment—mirroring the actual
NAB exam approach of testing real-world knowledge rather than theoretical concepts. Key topic areas include OBRA regulatory requirements,
quality assurance and performance improvement (QAPI), MDS 3.0 and resident assessment, payor mix and case mix management, Life Safety
Code inspection processes, infection control committees, resident fund management, medical records laws, and appropriate delegation and
supervision.
Each question includes the correct answer in bold green followed by a detailed rationale that reinforces statutory requirements under OBRA '87,
CMS guidelines, OSHA standards, and best practices in long-term care administration essential for NAB exam success and professional practice.
,Answer Format
All questions must be presented in bold text for clear distinction and readability.
All correct answers must be presented in bold and green, followed by clearly defined, legally focused rationales that reinforce federal nursing
home regulations, administrative best practices, and resident-centered care principles.
Domain 1: Resident Care Management (Questions 1-48)
Question 1: Under OBRA '87, how often must a comprehensive resident assessment be completed?
A) Within 7 days of admission
B) Within 14 days of admission
C) Within 30 days of admission
D) Within 60 days of admission
Correct Answer: B) Within 14 days of admission
Rationale: OBRA '87 requires a comprehensive resident assessment using the MDS (Minimum Data Set) within 14 days of admission. A preliminary
assessment must be completed within 72 hours. Annual reassessments are required, plus significant change assessments when condition changes.
Question 2: What is the primary purpose of the Resident Assessment Instrument (RAI)?
A) Billing and reimbursement only
B) Develop individualized care plans based on resident needs
C) Staff scheduling
D) Facility inspection preparation
Correct Answer: B) Develop individualized care plans based on resident needs
Rationale: The RAI (including MDS 3.0) is designed to comprehensively assess resident needs and develop individualized care plans. While it's used
for reimbursement (RUGs/PDPM), its primary purpose is resident-centered care planning and quality improvement.
Question 3: Under federal regulations, residents have the right to:
A) Choose their roommates only
B) Manage their personal funds
C) Both A and B
D) Neither A nor B
Correct Answer: C) Both A and B
, Rationale: OBRA '87 Resident Bill of Rights includes right to choose roommates (when feasible) and right to manage personal funds. Facilities must
provide financial services for residents who request assistance. These are fundamental resident rights under federal regulations.
Question 4: How often must fire drills be conducted in a nursing home?
A) Monthly on each shift
B) Quarterly on each shift
C) Semi-annually
D) Annually
Correct Answer: B) Quarterly on each shift
Rationale: Life Safety Code requires fire drills quarterly on each shift (day, evening, night). This ensures all staff are trained in emergency procedures.
Documentation of drills must be maintained. Some states may have more frequent requirements.
Question 5: What is the minimum staffing requirement for licensed nurses per day?
A) 4 consecutive hours
B) 8 consecutive hours
C) 12 consecutive hours
D) 24 consecutive hours
Correct Answer: B) 8 consecutive hours
Rationale: OBRA '87 requires licensed nurse (RN or LPN/LVN) coverage for at least 8 consecutive hours per day, 7 days per week. RN must be
present for at least 8 hours per day. Director of Nursing must be RN. Some states have more stringent requirements.
Question 6: What does QAPI stand for in long-term care?
A) Quality Assessment and Performance Improvement
B) Quality Assurance and Patient Inspection
C) Quality Assessment and Program Implementation
D) Quality Assurance and Performance Index
Correct Answer: A) Quality Assessment and Performance Improvement
Rationale: QAPI (Quality Assessment and Performance Improvement) is the CMS-mandated quality program combining QA and PI approaches.
Facilities must have QAPI committee, conduct ongoing monitoring, and implement performance improvement projects. Required under ACA 2010.
Question 7: How long must medical records be retained after a resident is discharged?
A) 3 years
, B) 5 years
C) 7 years
D) As required by state law
Correct Answer: D) As required by state law
Rationale: Federal regulations require medical records be retained for period required by state law. Most states require 5-10 years after discharge or
death. Some require longer for minors. Check specific state requirements. Records must be accessible for survey process.
Question 8: What is the primary purpose of a care plan conference?
A) Billing review
B) Involve resident/family in care planning
C) Staff evaluation
D) Survey preparation
Correct Answer: B) Involve resident/family in care planning
Rationale: Care plan conferences must involve resident and/or family to ensure resident-centered care. Required within 7 days after completion of
comprehensive assessment. Resident participation is a federal right. Plans must be reviewed quarterly or when condition changes.
Question 9: Under Medicare Part A, what is the maximum benefit period for skilled nursing facility care?
A) 60 days
B) 90 days
C) 100 days
D) 365 days
Correct Answer: C) 100 days
Rationale: Medicare Part A covers up to 100 days per benefit period in SNF. Days 1-20: 100% covered. Days 21-100: coinsurance required. Must
meet skilled need criteria. After 100 days, resident may qualify for Medicaid or private pay. Benefit period resets after 60 days without skilled care.
Question 10: What is the primary function of the Infection Control Committee?
A) Staff discipline
B) Develop and monitor infection prevention programs
C) Budget management
D) Resident admissions
Correct Answer: B) Develop and monitor infection prevention programs
