NAB NHA EXAMINATION — 250 PRACTICE
2025/2026 COMPLETE QUESTIONS WITH
CORRECT DETAILED ANSWERS
Here's a quick summary of coverage:
Domain 1 – Resident Care: Questions 1–70 (70 questions) Domain 2 – Human Resources:
Questions 71–120 (50 questions) Domain 3 – Finance: Questions 121–160 (40 questions)
Domain 4 – Environment of Care: Questions 161–200 (40 questions) Domain 5 – Leadership
& Management: Questions 201–250 (50 questions)
DOMAIN 1: RESIDENT CARE (Questions 1–70)
1. A resident with dementia repeatedly attempts to leave the facility. The MOST appropriate
least-restrictive intervention is:
A) Applying a vest restraint B) Locking the resident in their room C) Using a wander
guard/elopement alert system (correct answer) D) Sedating the resident with PRN medication
Rationale: Wander guard systems are the least restrictive, person-centered approach to
preventing elopement while preserving resident dignity and autonomy. Physical restraints
and sedation are more restrictive and carry significant risks.
2. Under OBRA 1987, a nursing home must conduct a comprehensive resident assessment
(MDS) within how many days of admission?
A) 7 days B) 14 days (correct answer) C) 21 days D) 30 days
Rationale: OBRA 1987 requires completion of the Minimum Data Set (MDS)
comprehensive assessment within 14 days of a resident's admission to ensure care planning
is based on thorough clinical evaluation.
,3. Which federal regulation requires nursing facilities to maintain a resident's "highest
practicable physical, mental, and psychosocial well-being"?
A) ADA B) HIPAA C) OBRA 1987 (correct answer) D) OSHA
Rationale: OBRA 1987 (Omnibus Budget Reconciliation Act) established the regulatory
foundation for nursing home quality of care, including the mandate to achieve the highest
practicable well-being for each resident.
4. A resident refuses to take their prescribed medication. The nurse's BEST response is to:
A) Crush the medication into food without telling the resident B) Document the refusal and
notify the physician (correct answer) C) Administer it anyway to protect the resident's health D)
Discharge the resident for non-compliance
Rationale: Residents have the right to refuse treatment under OBRA. The nurse must
document the refusal, notify the physician and family (if the resident consents), and update
the care plan. Covert medication administration is both unethical and illegal.
5. The primary purpose of the care conference is to:
A) Discuss billing and insurance matters B) Allow staff to report complaints about residents C)
Develop and update an individualized plan of care (correct answer) D) Conduct performance
evaluations of nursing staff
Rationale: Care conferences are interdisciplinary meetings focused on developing,
reviewing, and updating each resident's individualized care plan. They must include the
resident and family unless the resident declines.
6. A pressure injury with full-thickness tissue loss and visible subcutaneous fat is classified as:
A) Stage 1 B) Stage 2 C) Stage 3 (correct answer) D) Stage 4
Rationale: A Stage 3 pressure injury involves full-thickness skin loss with visible
subcutaneous fat. Bone, tendon, or muscle are NOT exposed at this stage. Stage 4 involves
exposed bone, tendon, or muscle.
7. Which of the following is an example of a chemical restraint?
,A) Side rails on the bed B) A geri-chair with a lap tray C) Administering haloperidol solely to
control wandering behavior (correct answer) D) A bed alarm system
Rationale: Chemical restraints are medications used to discipline or convenience staff, not
required to treat medical symptoms. Antipsychotics used solely to manage behavioral
symptoms like wandering (without a clinical indication) are considered chemical restraints
under F758 regulations.
8. The MDS 3.0 is used primarily to:
A) Bill Medicare and Medicaid exclusively B) Assess, plan care, and generate quality measures
for residents (correct answer) C) Credential nursing staff D) Document employee performance
Rationale: The MDS (Minimum Data Set) 3.0 serves multiple purposes: comprehensive
clinical assessment, care planning, quality measurement, and resource utilization. It is the
foundation of the RAI (Resident Assessment Instrument) process.
9. A resident's advance directive states they do not want CPR. The resident experiences cardiac
arrest. Staff should:
A) Perform CPR until family arrives B) Call 911 and perform CPR C) Follow the advance
directive and withhold CPR (correct answer) D) Consult the ethics committee before making a
decision
Rationale: Advance directives are legal documents that must be honored. A valid Do Not
Resuscitate (DNR) order means CPR should not be initiated. Staff must follow the
resident's documented wishes. Overriding a DNR is a violation of the resident's rights.
10. Which of the following BEST describes "person-centered care"?
A) Care guided by physician orders only B) Care that focuses on the institution's schedule and
efficiency C) Care that respects the resident's preferences, values, and choices (correct answer)
D) Care provided solely by licensed staff
Rationale: Person-centered care is a philosophy that treats residents as individuals with
unique preferences, histories, and goals. It prioritizes resident choice, dignity, and
autonomy over institutional routines.
, 11. Under CMS regulations, what is the minimum staffing requirement for a Director of Nursing
(DON) in a facility with more than 60 beds?
A) Part-time RN B) Full-time RN (correct answer) C) Licensed Practical Nurse D) Certified
Nursing Assistant
Rationale: CMS requires that facilities with more than 60 beds employ a full-time
Registered Nurse as Director of Nursing. Smaller facilities may use a part-time DON, but
an RN must be on duty at least 8 consecutive hours daily.
12. A resident has a right to:
A) Choose their roommate in all circumstances B) Access their own medical records (correct
answer) C) Refuse all dietary modifications D) Demand private accommodation regardless of
bed availability
Rationale: Under OBRA and 42 CFR Part 483, residents have the right to inspect and
receive copies of their medical records upon request within 24 hours. This is a fundamental
resident right.
13. The RAP (Resident Assessment Protocol) is triggered when:
A) A resident is discharged B) An MDS item score reaches a threshold indicating a potential care
concern (correct answer) C) A family member files a complaint D) The state survey team
arrives
Rationale: RAPs (now called Care Area Assessments/CAAs in MDS 3.0) are triggered by
specific MDS responses. They prompt the care team to further assess triggered care areas
(e.g., falls, cognitive loss, nutritional status) to determine if a care plan intervention is
needed.
14. Urinary incontinence in a nursing home resident should be:
A) Accepted as a normal part of aging B) Addressed in the care plan with individualized
interventions (correct answer) C) Managed only with catheters D) Reported to the state health
department
Rationale: Incontinence is NOT an inevitable consequence of aging. Regulations require
that residents who are incontinent receive proper treatment and services to prevent UTIs
and skin breakdown, and to restore continence if possible.
2025/2026 COMPLETE QUESTIONS WITH
CORRECT DETAILED ANSWERS
Here's a quick summary of coverage:
Domain 1 – Resident Care: Questions 1–70 (70 questions) Domain 2 – Human Resources:
Questions 71–120 (50 questions) Domain 3 – Finance: Questions 121–160 (40 questions)
Domain 4 – Environment of Care: Questions 161–200 (40 questions) Domain 5 – Leadership
& Management: Questions 201–250 (50 questions)
DOMAIN 1: RESIDENT CARE (Questions 1–70)
1. A resident with dementia repeatedly attempts to leave the facility. The MOST appropriate
least-restrictive intervention is:
A) Applying a vest restraint B) Locking the resident in their room C) Using a wander
guard/elopement alert system (correct answer) D) Sedating the resident with PRN medication
Rationale: Wander guard systems are the least restrictive, person-centered approach to
preventing elopement while preserving resident dignity and autonomy. Physical restraints
and sedation are more restrictive and carry significant risks.
2. Under OBRA 1987, a nursing home must conduct a comprehensive resident assessment
(MDS) within how many days of admission?
A) 7 days B) 14 days (correct answer) C) 21 days D) 30 days
Rationale: OBRA 1987 requires completion of the Minimum Data Set (MDS)
comprehensive assessment within 14 days of a resident's admission to ensure care planning
is based on thorough clinical evaluation.
,3. Which federal regulation requires nursing facilities to maintain a resident's "highest
practicable physical, mental, and psychosocial well-being"?
A) ADA B) HIPAA C) OBRA 1987 (correct answer) D) OSHA
Rationale: OBRA 1987 (Omnibus Budget Reconciliation Act) established the regulatory
foundation for nursing home quality of care, including the mandate to achieve the highest
practicable well-being for each resident.
4. A resident refuses to take their prescribed medication. The nurse's BEST response is to:
A) Crush the medication into food without telling the resident B) Document the refusal and
notify the physician (correct answer) C) Administer it anyway to protect the resident's health D)
Discharge the resident for non-compliance
Rationale: Residents have the right to refuse treatment under OBRA. The nurse must
document the refusal, notify the physician and family (if the resident consents), and update
the care plan. Covert medication administration is both unethical and illegal.
5. The primary purpose of the care conference is to:
A) Discuss billing and insurance matters B) Allow staff to report complaints about residents C)
Develop and update an individualized plan of care (correct answer) D) Conduct performance
evaluations of nursing staff
Rationale: Care conferences are interdisciplinary meetings focused on developing,
reviewing, and updating each resident's individualized care plan. They must include the
resident and family unless the resident declines.
6. A pressure injury with full-thickness tissue loss and visible subcutaneous fat is classified as:
A) Stage 1 B) Stage 2 C) Stage 3 (correct answer) D) Stage 4
Rationale: A Stage 3 pressure injury involves full-thickness skin loss with visible
subcutaneous fat. Bone, tendon, or muscle are NOT exposed at this stage. Stage 4 involves
exposed bone, tendon, or muscle.
7. Which of the following is an example of a chemical restraint?
,A) Side rails on the bed B) A geri-chair with a lap tray C) Administering haloperidol solely to
control wandering behavior (correct answer) D) A bed alarm system
Rationale: Chemical restraints are medications used to discipline or convenience staff, not
required to treat medical symptoms. Antipsychotics used solely to manage behavioral
symptoms like wandering (without a clinical indication) are considered chemical restraints
under F758 regulations.
8. The MDS 3.0 is used primarily to:
A) Bill Medicare and Medicaid exclusively B) Assess, plan care, and generate quality measures
for residents (correct answer) C) Credential nursing staff D) Document employee performance
Rationale: The MDS (Minimum Data Set) 3.0 serves multiple purposes: comprehensive
clinical assessment, care planning, quality measurement, and resource utilization. It is the
foundation of the RAI (Resident Assessment Instrument) process.
9. A resident's advance directive states they do not want CPR. The resident experiences cardiac
arrest. Staff should:
A) Perform CPR until family arrives B) Call 911 and perform CPR C) Follow the advance
directive and withhold CPR (correct answer) D) Consult the ethics committee before making a
decision
Rationale: Advance directives are legal documents that must be honored. A valid Do Not
Resuscitate (DNR) order means CPR should not be initiated. Staff must follow the
resident's documented wishes. Overriding a DNR is a violation of the resident's rights.
10. Which of the following BEST describes "person-centered care"?
A) Care guided by physician orders only B) Care that focuses on the institution's schedule and
efficiency C) Care that respects the resident's preferences, values, and choices (correct answer)
D) Care provided solely by licensed staff
Rationale: Person-centered care is a philosophy that treats residents as individuals with
unique preferences, histories, and goals. It prioritizes resident choice, dignity, and
autonomy over institutional routines.
, 11. Under CMS regulations, what is the minimum staffing requirement for a Director of Nursing
(DON) in a facility with more than 60 beds?
A) Part-time RN B) Full-time RN (correct answer) C) Licensed Practical Nurse D) Certified
Nursing Assistant
Rationale: CMS requires that facilities with more than 60 beds employ a full-time
Registered Nurse as Director of Nursing. Smaller facilities may use a part-time DON, but
an RN must be on duty at least 8 consecutive hours daily.
12. A resident has a right to:
A) Choose their roommate in all circumstances B) Access their own medical records (correct
answer) C) Refuse all dietary modifications D) Demand private accommodation regardless of
bed availability
Rationale: Under OBRA and 42 CFR Part 483, residents have the right to inspect and
receive copies of their medical records upon request within 24 hours. This is a fundamental
resident right.
13. The RAP (Resident Assessment Protocol) is triggered when:
A) A resident is discharged B) An MDS item score reaches a threshold indicating a potential care
concern (correct answer) C) A family member files a complaint D) The state survey team
arrives
Rationale: RAPs (now called Care Area Assessments/CAAs in MDS 3.0) are triggered by
specific MDS responses. They prompt the care team to further assess triggered care areas
(e.g., falls, cognitive loss, nutritional status) to determine if a care plan intervention is
needed.
14. Urinary incontinence in a nursing home resident should be:
A) Accepted as a normal part of aging B) Addressed in the care plan with individualized
interventions (correct answer) C) Managed only with catheters D) Reported to the state health
department
Rationale: Incontinence is NOT an inevitable consequence of aging. Regulations require
that residents who are incontinent receive proper treatment and services to prevent UTIs
and skin breakdown, and to restore continence if possible.
