FEDERAL NURSING HOME
ADMINISTRATOR EXAM
2026/2027 Complete Study Guide & Practice Questions
75 Practice Questions Across All Core Domains
Exam Structure Overview
Question Format Core Domains Passing Score
• 150 Multiple-choice questions • Federal Regulations & • Typically 70-75%
• Single-best-answer format Compliance • Competency-based assessment
• Scenario-based decision- • Healthcare Administration • Results valid for exam
making items • Resident Rights & Quality Care eligibility
• 2-3 hour time limit • Financial Management
• Human Resources
• Infection Prevention
• Risk Management
• Survey Process
• Ethical & Legal Responsibilities
Domain 1: Federal Long-Term Care Regulations (Questions 1-15)
Question 1
According to CMS regulations, what is the minimum required timeframe for
completing a comprehensive assessment for all residents?
A) Within 7 days of admission
B) Within 14 days of admission
C) Within 24 hours of admission
D) Within 30 days of admission
Correct Answer: B) Within 14 days of admission
Rationale: Federal regulations under the Medicare/Medicaid conditions of participation require that
a comprehensive assessment (Minimum Data Set - MDS) be completed no later than 14 days after
admission. This assessment forms the foundation for the resident's care plan and must be conducted by
qualified nursing staff.
Question 2
A nursing home administrator receives a complaint about potential abuse. What is
the immediate regulatory requirement under federal law?
A) Investigate within 24 hours and report to state authorities
, B) Document the complaint and monitor the situation
C) Report to law enforcement within 2 hours regardless of investigation
D) Wait for survey team arrival before taking action
Correct Answer: A) Investigate within 24 hours and report to state authorities
Rationale: Federal regulations (42 CFR §483.12) mandate that alleged violations of resident rights,
including abuse, neglect, or mistreatment, must be thoroughly investigated within 24 hours. Findings
must be reported to state authorities, and corrective actions must be implemented immediately.
Question 3
Under federal law, what is the minimum staffing requirement for registered nurses
in skilled nursing facilities?
A) RN on duty 24 hours per day, 7 days per week
B) RN on duty at least 8 hours per day, 7 days per week
C) RN available on call 24 hours per day
D) RN supervision required only during medication administration
Correct Answer: B) RN on duty at least 8 hours per day, 7 days per week
Rationale: CMS requires that a registered nurse must be on duty at least 8 consecutive hours per day,
7 days per week. Additionally, a licensed nurse (RN or LPN) must be on duty the remaining 16 hours
per day. This ensures adequate supervision for resident care.
Question 4
What is the federal requirement for nursing facility staff training on resident rights?
A) Initial training only upon hire
B) Annual training plus additional as needed
C) Training only when new regulations are published
D) No specific federal requirement exists
Correct Answer: B) Annual training plus additional as needed
Rationale: Federal regulations require that all staff receive training on resident rights upon hire and
annually thereafter. Additional training must be provided when new regulations are implemented or
when deficiencies in practice are identified.
Question 5
Under the Emergency Preparedness and Response rule, what must a facility have in
place?
, A) Annual evacuation drills only
B) Comprehensive emergency plan addressing various scenarios
C) Fire safety plan only
D) Written agreement with local hospital only
Correct Answer: B) Comprehensive emergency plan addressing various scenarios
Rationale: The CMS Emergency Preparedness Rule requires nursing homes to have a comprehensive
emergency plan addressing natural disasters, pandemics, power outages, and other emergencies. This
includes staff training, evacuation procedures, and coordination with local emergency management
agencies.
Question 6
What is the federal requirement for maintaining clinical records in nursing
facilities?
A) 3 years from date of discharge
B) 5 years from date of discharge
C) 7 years from date of discharge
D) Permanently after digitization
Correct Answer: C) 7 years from date of discharge
Rationale: Federal regulations require nursing facilities to maintain clinical records for at least 7
years after a resident is discharged. This applies to all medical records, assessments, care plans, and
documentation of care provided.
Question 7
Under HIPAA Privacy Rule, what is the minimum retention period for protected
health information (PHI)?
A) 5 years
B) 6 years from creation or last effective date
C) 10 years
D) Permanently
Correct Answer: B) 6 years from creation or last effective date
Rationale: HIPAA requires covered entities to retain PHI for 6 years from the date of creation or the
last effective date. This applies to all forms of PHI, including paper and electronic records, though
states may have longer requirements.
, Question 8
What is the federal requirement for medication error reporting in nursing facilities?
A) Report all errors to Medicare within 24 hours
B) Report only errors causing harm to residents
C) Report all errors through internal quality assurance program
D) No federal reporting requirement exists
Correct Answer: C) Report all errors through internal quality assurance program
Rationale: Federal regulations require facilities to have a medication error reporting and tracking
system as part of their quality assurance program. While not all errors must be reported externally,
they must be documented, analyzed, and addressed internally to prevent recurrence.
Question 9
Under federal law, what is the minimum background check requirement for direct
care staff?
A) State criminal background check only
B) FBI fingerprinting and state background check
C) Reference checks only
D) No federal requirement exists
Correct Answer: B) FBI fingerprinting and state background check
Rationale: Federal law requires all nursing facilities to conduct comprehensive background checks
including FBI fingerprinting and state-level criminal history checks for all direct care staff to ensure
resident safety and prevent abuse.
Question 10
What is the federal requirement for infection control and prevention programs?
A) Optional program based on facility preference
B) Must follow CDC guidelines for healthcare settings
C) Only required during declared outbreaks
D) State requirements only
Correct Answer: B) Must follow CDC guidelines for healthcare settings
Rationale: Federal regulations require nursing facilities to have an infection prevention and control
program that meets or exceeds CDC guidelines for healthcare settings. This includes surveillance, staff
training, isolation procedures, and antibiotic stewardship.
ADMINISTRATOR EXAM
2026/2027 Complete Study Guide & Practice Questions
75 Practice Questions Across All Core Domains
Exam Structure Overview
Question Format Core Domains Passing Score
• 150 Multiple-choice questions • Federal Regulations & • Typically 70-75%
• Single-best-answer format Compliance • Competency-based assessment
• Scenario-based decision- • Healthcare Administration • Results valid for exam
making items • Resident Rights & Quality Care eligibility
• 2-3 hour time limit • Financial Management
• Human Resources
• Infection Prevention
• Risk Management
• Survey Process
• Ethical & Legal Responsibilities
Domain 1: Federal Long-Term Care Regulations (Questions 1-15)
Question 1
According to CMS regulations, what is the minimum required timeframe for
completing a comprehensive assessment for all residents?
A) Within 7 days of admission
B) Within 14 days of admission
C) Within 24 hours of admission
D) Within 30 days of admission
Correct Answer: B) Within 14 days of admission
Rationale: Federal regulations under the Medicare/Medicaid conditions of participation require that
a comprehensive assessment (Minimum Data Set - MDS) be completed no later than 14 days after
admission. This assessment forms the foundation for the resident's care plan and must be conducted by
qualified nursing staff.
Question 2
A nursing home administrator receives a complaint about potential abuse. What is
the immediate regulatory requirement under federal law?
A) Investigate within 24 hours and report to state authorities
, B) Document the complaint and monitor the situation
C) Report to law enforcement within 2 hours regardless of investigation
D) Wait for survey team arrival before taking action
Correct Answer: A) Investigate within 24 hours and report to state authorities
Rationale: Federal regulations (42 CFR §483.12) mandate that alleged violations of resident rights,
including abuse, neglect, or mistreatment, must be thoroughly investigated within 24 hours. Findings
must be reported to state authorities, and corrective actions must be implemented immediately.
Question 3
Under federal law, what is the minimum staffing requirement for registered nurses
in skilled nursing facilities?
A) RN on duty 24 hours per day, 7 days per week
B) RN on duty at least 8 hours per day, 7 days per week
C) RN available on call 24 hours per day
D) RN supervision required only during medication administration
Correct Answer: B) RN on duty at least 8 hours per day, 7 days per week
Rationale: CMS requires that a registered nurse must be on duty at least 8 consecutive hours per day,
7 days per week. Additionally, a licensed nurse (RN or LPN) must be on duty the remaining 16 hours
per day. This ensures adequate supervision for resident care.
Question 4
What is the federal requirement for nursing facility staff training on resident rights?
A) Initial training only upon hire
B) Annual training plus additional as needed
C) Training only when new regulations are published
D) No specific federal requirement exists
Correct Answer: B) Annual training plus additional as needed
Rationale: Federal regulations require that all staff receive training on resident rights upon hire and
annually thereafter. Additional training must be provided when new regulations are implemented or
when deficiencies in practice are identified.
Question 5
Under the Emergency Preparedness and Response rule, what must a facility have in
place?
, A) Annual evacuation drills only
B) Comprehensive emergency plan addressing various scenarios
C) Fire safety plan only
D) Written agreement with local hospital only
Correct Answer: B) Comprehensive emergency plan addressing various scenarios
Rationale: The CMS Emergency Preparedness Rule requires nursing homes to have a comprehensive
emergency plan addressing natural disasters, pandemics, power outages, and other emergencies. This
includes staff training, evacuation procedures, and coordination with local emergency management
agencies.
Question 6
What is the federal requirement for maintaining clinical records in nursing
facilities?
A) 3 years from date of discharge
B) 5 years from date of discharge
C) 7 years from date of discharge
D) Permanently after digitization
Correct Answer: C) 7 years from date of discharge
Rationale: Federal regulations require nursing facilities to maintain clinical records for at least 7
years after a resident is discharged. This applies to all medical records, assessments, care plans, and
documentation of care provided.
Question 7
Under HIPAA Privacy Rule, what is the minimum retention period for protected
health information (PHI)?
A) 5 years
B) 6 years from creation or last effective date
C) 10 years
D) Permanently
Correct Answer: B) 6 years from creation or last effective date
Rationale: HIPAA requires covered entities to retain PHI for 6 years from the date of creation or the
last effective date. This applies to all forms of PHI, including paper and electronic records, though
states may have longer requirements.
, Question 8
What is the federal requirement for medication error reporting in nursing facilities?
A) Report all errors to Medicare within 24 hours
B) Report only errors causing harm to residents
C) Report all errors through internal quality assurance program
D) No federal reporting requirement exists
Correct Answer: C) Report all errors through internal quality assurance program
Rationale: Federal regulations require facilities to have a medication error reporting and tracking
system as part of their quality assurance program. While not all errors must be reported externally,
they must be documented, analyzed, and addressed internally to prevent recurrence.
Question 9
Under federal law, what is the minimum background check requirement for direct
care staff?
A) State criminal background check only
B) FBI fingerprinting and state background check
C) Reference checks only
D) No federal requirement exists
Correct Answer: B) FBI fingerprinting and state background check
Rationale: Federal law requires all nursing facilities to conduct comprehensive background checks
including FBI fingerprinting and state-level criminal history checks for all direct care staff to ensure
resident safety and prevent abuse.
Question 10
What is the federal requirement for infection control and prevention programs?
A) Optional program based on facility preference
B) Must follow CDC guidelines for healthcare settings
C) Only required during declared outbreaks
D) State requirements only
Correct Answer: B) Must follow CDC guidelines for healthcare settings
Rationale: Federal regulations require nursing facilities to have an infection prevention and control
program that meets or exceeds CDC guidelines for healthcare settings. This includes surveillance, staff
training, isolation procedures, and antibiotic stewardship.
