North Carolina Assisted Living Administrator Exam Exam Questions & Correct Answers Plus Rationales 2026

1. An applicant for a North Carolina assisted living administrator license must complete a state-approved training program and pass the state exam. What is the minimum age requirement to be licensed? A) 18 years B) 21 years C) 25 years D) No minimum age Correct Answer: B Rationale: N.C. law requires assisted living administrators to be at least 21 years old. This ensures a minimum level of maturity and legal capacity to manage resident care, finances, and regulatory compliance. 2. A resident with a documented history of wandering is admitted. The administrator must ensure which of the following is in place within 24 hours? A) A bed alarm only B) A secured perimeter alarm and individualized wandering prevention plan C) Chemical restraints as needed D) One-on-one staff supervision at all times Correct Answer: B Rationale: 10A NCAC 13F .1001 requires a secured perimeter alarm system for residents at risk of elopement. An individualized plan must address wandering without using restraints as a first-line intervention. 3. Which of the following is NOT a required component of the negotiated risk agreement in an NC assisted living facility?A) Resident’s specific choice to accept a certain risk B) Facility’s agreement to accommodate the resident’s choice C) Waiver of the facility’s liability for all injuries D) Physician or health care professional input Correct Answer: C Rationale: Negotiated risk cannot waive liability for negligence. The agreement documents informed consent and accommodations, but the facility remains responsible for providing a safe environment consistent with regulations. 4. Under the Medication Aide rules in NC, a certified medication aide working in assisted living may administer which of the following? A) IV antibiotics B) PRN narcotics without a new order each time C) Routine oral, topical, and ophthalmic medications from a blister pack D) Chemotherapy agents Correct Answer: C Rationale: Medication Aides (registered with the NC Board of Nursing) are limited to administering routine medications via oral, topical, ophthalmic, otic, nasal, and rectal routes. IV and chemotherapy are beyond scope. 5. A resident’s family requests to install a camera in the resident’s private room. The administrator should: A) Allow it immediately to promote family involvement B) Prohibit all cameras under all circumstances C) Assess based on resident consent, roommate consent (if any), and facility policy; no law explicitly bans, but privacy must be protected D) Require a court order first Correct Answer: C Rationale: NC law does not specifically forbid cameras in private rooms, but consent of all parties (resident, roommate) is essential. The facility must balance safety, privacy, and dignity.6. An administrator discovers that a staff member has been taking photos of residents without consent using a personal phone. The administrator’s FIRST action should be: A) Fire the staff member immediately B) Confiscate the phone and review images, then report to law enforcement C) Implement a corrective action plan and report to the NC Long Term Care Ombudsman D) Call the resident’s family to apologize Correct Answer: B Rationale: Unauthorized photography may violate resident privacy rights and can be a crime. The administrator must secure evidence, protect residents, and determine if a criminal violation occurred. 7. According to 10A NCAC 13F .0304, the admission agreement must include all EXCEPT: A) The daily or monthly rate and any extra charges B) A statement that the facility is not liable for any theft of resident property C) The facility’s own personal needs allowance policy D) The discharge and transfer policy Correct Answer: B Rationale: Facilities cannot fully disclaim liability for theft; they must exercise reasonable care. Admission agreements cannot include provisions contrary to law or that limit statutory liability. 8. What is the maximum number of residents permitted in a single adult care home (assisted living) residence? A) 6 B) 12 C) No limit by number but by square footage and zoning D) 100 Correct Answer: C Rationale: NC assisted living includes both small (family care homes, 2-6 beds) and large (adult care homes, 7+ beds). There is no absolute cap of 6 or 12 for all types; largehomes can have many resident beds as long as they meet physical plant and staffing requirements. 9. A resident has a stage 2 pressure ulcer upon admission from a hospital. The administrator must ensure: A) The resident is discharged to a nursing home within 7 days B) A comprehensive care plan with weekly skin assessments and wound care by licensed nurse C) Only family can provide wound care D) The facility does not admit anyone with a pressure ulcer Correct Answer: B Rationale: Assisted living can admit and care for pressure ulcers stage 2 or less if they can meet the resident’s needs. A plan with licensed nursing oversight is required; stage 3/4 typically require nursing home. 10. The administrator is reviewing a incident report where a resident fell and sustained a small bruise. What is the required reporting timeframe to the Division of Health Service Regulation (DHSR) for this non-serious fall? A) Immediately by phone B) Within 24 hours by phone C) Within 7 days in writing D) No report required unless a fracture or hospitalization occurred Correct Answer: D Rationale: NC DHSR requires reporting of incidents that result in serious injury requiring emergency care, fracture, hospitalization, or death. Minor bruise does not trigger mandatory DHSR notification but must be documented internally. 11. A medication aide makes an error giving a double dose of a beta blocker. Resident is asymptomatic. What is the nurse’s and administrator’s responsibility? A) Ignore if no harm B) Notify the physician, monitor vital signs, document, and report as medication error in facility QAC) Fire the medication aide D) Only document in the medication record Correct Answer: B Rationale: All medication errors require physician notification, resident monitoring, and documentation. Even if no immediate harm, it must be reviewed in quality assurance and may be reportable depending on outcome.