FEDERAL NURSING HOME ADMINISTRATOR EXAM
2026/2027 Edition | 160 Verified Questions
────────────────────────────────────────
NAB Core of Knowledge Assessment
National Association of Long Term Care Administrator Boards
Complete Questions & Verified Solutions | Federal NHA Examination
Updated Per Latest CMS & NAB Guidelines | Graded A+
Key Features
✓ Federal and state regulations governing long-term care facilities (CMS Conditions of
Participation)
✓ Resident care, quality assurance, and clinical service management
✓ Facility operations, environment of care, and infection control protocols
✓ Human resources management, staff training, and labor relations
✓ Financial management, budgeting, and Medicare/Medicaid reimbursement
Updates for 2026
• Updated CMS Final Rule requirements for nursing home staffing minimums and
financial transparency: The Centers for Medicare & Medicaid Services has finalized updated
staffing minimum requirements for nursing facilities participating in Medicare and Medicaid,
mandating a minimum of 0.55 hours per resident day (HPRD) of direct registered nurse care and
2.45 total nursing HPRD. Additionally, facilities must publicly disclose detailed ownership and
financial disclosure information to enhance transparency and accountability.
• Revised F-Tags for State Surveyor enforcement and compliance standards: CMS has
updated the State Operations Manual (SOM) Appendix PP with revised F-Tag designations and
interpretive guidance. Key changes include enhanced surveyor protocols for investigating
complaints related to abuse, neglect, and exploitation under F-Tags 600, 610, and 620. New F-
Tags address emergency preparedness standards and infection prevention and control
requirements.
• New federal guidelines for infection control, antibiotic stewardship, and
emergency preparedness in long-term care: In response to evolving public health threats,
CMS has issued updated guidance for long-term care facilities implementing comprehensive
antibiotic stewardship programs, enhanced surveillance protocols for multi-drug resistant
organisms, and revised emergency preparedness requirements under F-Tags 881-886. Facilities
must demonstrate capability for maintaining continuity of operations during natural disasters
and pandemic events.
,Abstract
This actual exam document provides a comprehensive, evidence-based assessment of the
knowledge required for federal nursing home administrator licensure as defined by the National
Association of Long Term Care Administrator Boards (NAB) Core of Knowledge domains. The
160 questions span five critical content areas: resident care and quality of life, physical
environment and infection control, leadership and human resources management, financial
management and reimbursement, and federal and state regulations. Each question is designed to
reinforce understanding of regulatory compliance, quality assurance processes, person-centered
care delivery, and the organizational leadership skills essential for effective long-term care facility
management. The content aligns with current CMS Conditions of Participation (42 CFR Part
483), the State Operations Manual (SOM), and the latest NAB examination blueprint, promoting
the critical thinking and applied administrative knowledge required for competent facility
operation and regulatory readiness.
Keywords
NAB, Nursing Home Administrator, NHA, Long-Term Care Administration, CMS Regulations,
F-Tags, Resident Care, Facility Operations, Medicare/Medicaid, Quality Assurance, Conditions
of Participation, Survey Process, Person-Centered Care, Infection Control, Financial
Management, Staffing, State Operations Manual
Content Area Overview
Content Area Questions Key Topics Weight
Resident Care & Quality of 40 Resident rights, person-centered care, 25%
Life quality measures, MDS assessments,
care planning, psychosocial wellbeing,
abuse prevention
Physical Environment & 32 Life safety, emergency preparedness, 20%
Infection Control infection prevention, maintenance, food
service, environmental safety
Leadership, Human 32 Organizational management, staffing 20%
Resources & Staffing models, training, labor law, performance
management, governance, team
leadership
Financial Management & 28 Medicare/Medicaid, PPS/RUGs, 17.5%
Reimbursement budgeting, census management,
accounts receivable, cost reports, capital
planning
Federal & State Regulations 28 CMS CoP, F-Tags, survey process, 17.5%
licensure, OSHA, ADA, compliance
programs, regulatory standards
,Examination Questions
Domain 1: Resident Care & Quality of Life (Q1–Q40)
Q1. A nursing home administrator receives a complaint from a resident who states
that staff entered her room without knocking and opened her personal drawer
while she was in the bathroom. Under 42 CFR 483.10, which resident right is most
directly implicated in this situation?
A) The right to be free from abuse, neglect, and exploitation
B) The right to privacy and confidentiality of personal and clinical records
[Correct]
C) The right to dignity and respect in the provision of care and services
D) The right to choose a personal physician and to be fully informed about medical care
Correct Answer: B
Rationale: 42 CFR 483.10(c) guarantees each resident the right to personal privacy, which
includes the right to have personal mail, telephone conversations, and visits be treated as
confidential. Staff entering a room unannounced and accessing a resident's personal belongings
without permission is a direct violation of the resident's right to privacy. While dignity (C) is a
related concern, the specific act of accessing personal property without consent most directly
implicates the privacy right. The administrator must ensure that policies are in place and staff
are trained on knock-and-wait procedures and respecting residents' personal spaces.
Why Wrong: A is incorrect because Abuse, neglect, and exploitation (42 CFR 483.10(b))
involve more egregious acts of harm or financial misconduct. Unauthorized room entry, while a
rights violation, does not rise to the level of abuse or neglect in this context. | C is incorrect
because Dignity and respect (42 CFR 483.10(a)) is a broader right that encompasses courteous
treatment. While this situation may affect dignity, the specific act of accessing a personal
drawer is more precisely a privacy violation. | D is incorrect because The right to choose a
physician and be informed (42 CFR 483.10(d)) relates to medical decision-making autonomy,
which is unrelated to the scenario described.
Reference: 42 CFR 483.10(c); NAB Core of Knowledge Domain 1: Resident Rights
────────────────────────────────────────────────────────────
Q2. A nursing home administrator is reviewing the facility's person-centered care
approach. Which of the following actions by the administrator best demonstrates
commitment to person-centered care according to CMS regulatory standards?
A) Ensuring all care plans are completed within 14 days of admission and filed in the medical
record
B) Implementing a system where residents choose their own wake-up times,
meal schedules, and daily routines [Correct]
C) Assigning each resident a primary nurse who is responsible for all clinical decisions on the
care team
D) Requiring all staff to sign an acknowledgment form confirming they have read the person-
centered care policy
Correct Answer: B
Rationale: Person-centered care, as defined under 42 CFR 483.21, requires that each resident
receives care that honors their individual preferences, values, and needs. Allowing residents to
choose their own wake-up times, meal schedules, and daily routines directly reflects the
principles of person-centered care by giving residents control over their daily lives. This
approach moves away from institution-centered scheduling toward individualized routines. The
administrator's role is to establish systems and empower staff to support these choices while
maintaining safe care delivery.
Why Wrong: A is incorrect because Completing care plans within the regulatory timeframe is
a compliance requirement but does not inherently reflect person-centered care. A care plan can
be completed on time yet still reflect an institutional rather than individualized approach. | C is
incorrect because Assigning a primary nurse is a care delivery model decision but does not
, guarantee person-centered care. Person-centered care requires input from the resident and
interdisciplinary team, not just assignment of a single clinician. | D is incorrect because Having
staff sign an acknowledgment form is a documentation exercise that does not translate into
actual behavioral change or person-centered care delivery. It demonstrates compliance with a
policy requirement, not the implementation of person-centered principles.
Reference: 42 CFR 483.21; CMS SOM Appendix PP, F-Tag 655; NAB Core of Knowledge Domain
1
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Q3. A nursing home administrator is analyzing the facility's Quality Measure (QM)
report and identifies that the facility's percentile for "Percent of Residents with
Falls" is at the 90th percentile. Which action should the administrator take first?
A) Terminate the director of nursing for failing to maintain adequate fall prevention
protocols
B) Convene the Quality Assurance and Performance Improvement (QAPI)
committee to conduct a root cause analysis [Correct]
C) Immediately report the high fall rate to the state survey agency as a condition of
participation deficiency
D) Increase staffing ratios on all shifts by adding two nursing assistants per floor
Correct Answer: B
Rationale: A QM at the 90th percentile means the facility is performing worse than 90% of
nursing homes nationally on falls. The appropriate administrative response is to use the
facility's QAPI process to conduct a systematic root cause analysis. QAPI, required under 42
CFR 483.75, is the framework through which facilities identify, analyze, and improve quality
concerns. The administrator should lead the QAPI committee in reviewing fall data, identifying
contributing factors, and developing targeted interventions. This systematic approach
addresses the root causes rather than applying superficial fixes.
Why Wrong: A is incorrect because Terminating a department head without first conducting a
thorough analysis is not appropriate leadership. The administrator must understand the
systemic factors contributing to falls before assigning individual accountability. | C is incorrect
because A high QM percentile is not an immediate jeopardy situation that requires self-
reporting to the state. It does indicate a need for focused improvement, but it is addressed
internally through QAPI before any external reporting would be considered. | D is incorrect
because Increasing staffing ratios without data analysis may not address the actual causes of
falls and is not a targeted intervention. Falls can result from environmental factors, medication
side effects, clinical conditions, and other causes that additional staff alone may not mitigate.
Reference: 42 CFR 483.75; CMS Quality Measures; NAB Core of Knowledge Domain 1: Quality
Assurance and Performance Improvement
────────────────────────────────────────────────────────────
Q4. Under 42 CFR 483.10, which of the following are guaranteed resident rights?
(Select all that apply)
A) The right to be free from physical restraints that are not required to treat the
resident's medical symptoms [Correct]
B) The right to participate in planning care and treatment or changes in care
and treatment [Correct]
C) The right to have the facility refuse to admit a resident whose care needs exceed the
facility's capabilities
D) The right to be fully informed, in language that the resident understands, of
his or her total health status [Correct]
Correct Answer: A, B, D
Rationale: 42 CFR 483.10 enumerates specific resident rights. Option A reflects 42 CFR
483.10(a)(2), which guarantees freedom from unnecessary physical restraints. Option B reflects
42 CFR 483.10(e)(1), which ensures the right to participate in care planning. Option D reflects
2026/2027 Edition | 160 Verified Questions
────────────────────────────────────────
NAB Core of Knowledge Assessment
National Association of Long Term Care Administrator Boards
Complete Questions & Verified Solutions | Federal NHA Examination
Updated Per Latest CMS & NAB Guidelines | Graded A+
Key Features
✓ Federal and state regulations governing long-term care facilities (CMS Conditions of
Participation)
✓ Resident care, quality assurance, and clinical service management
✓ Facility operations, environment of care, and infection control protocols
✓ Human resources management, staff training, and labor relations
✓ Financial management, budgeting, and Medicare/Medicaid reimbursement
Updates for 2026
• Updated CMS Final Rule requirements for nursing home staffing minimums and
financial transparency: The Centers for Medicare & Medicaid Services has finalized updated
staffing minimum requirements for nursing facilities participating in Medicare and Medicaid,
mandating a minimum of 0.55 hours per resident day (HPRD) of direct registered nurse care and
2.45 total nursing HPRD. Additionally, facilities must publicly disclose detailed ownership and
financial disclosure information to enhance transparency and accountability.
• Revised F-Tags for State Surveyor enforcement and compliance standards: CMS has
updated the State Operations Manual (SOM) Appendix PP with revised F-Tag designations and
interpretive guidance. Key changes include enhanced surveyor protocols for investigating
complaints related to abuse, neglect, and exploitation under F-Tags 600, 610, and 620. New F-
Tags address emergency preparedness standards and infection prevention and control
requirements.
• New federal guidelines for infection control, antibiotic stewardship, and
emergency preparedness in long-term care: In response to evolving public health threats,
CMS has issued updated guidance for long-term care facilities implementing comprehensive
antibiotic stewardship programs, enhanced surveillance protocols for multi-drug resistant
organisms, and revised emergency preparedness requirements under F-Tags 881-886. Facilities
must demonstrate capability for maintaining continuity of operations during natural disasters
and pandemic events.
,Abstract
This actual exam document provides a comprehensive, evidence-based assessment of the
knowledge required for federal nursing home administrator licensure as defined by the National
Association of Long Term Care Administrator Boards (NAB) Core of Knowledge domains. The
160 questions span five critical content areas: resident care and quality of life, physical
environment and infection control, leadership and human resources management, financial
management and reimbursement, and federal and state regulations. Each question is designed to
reinforce understanding of regulatory compliance, quality assurance processes, person-centered
care delivery, and the organizational leadership skills essential for effective long-term care facility
management. The content aligns with current CMS Conditions of Participation (42 CFR Part
483), the State Operations Manual (SOM), and the latest NAB examination blueprint, promoting
the critical thinking and applied administrative knowledge required for competent facility
operation and regulatory readiness.
Keywords
NAB, Nursing Home Administrator, NHA, Long-Term Care Administration, CMS Regulations,
F-Tags, Resident Care, Facility Operations, Medicare/Medicaid, Quality Assurance, Conditions
of Participation, Survey Process, Person-Centered Care, Infection Control, Financial
Management, Staffing, State Operations Manual
Content Area Overview
Content Area Questions Key Topics Weight
Resident Care & Quality of 40 Resident rights, person-centered care, 25%
Life quality measures, MDS assessments,
care planning, psychosocial wellbeing,
abuse prevention
Physical Environment & 32 Life safety, emergency preparedness, 20%
Infection Control infection prevention, maintenance, food
service, environmental safety
Leadership, Human 32 Organizational management, staffing 20%
Resources & Staffing models, training, labor law, performance
management, governance, team
leadership
Financial Management & 28 Medicare/Medicaid, PPS/RUGs, 17.5%
Reimbursement budgeting, census management,
accounts receivable, cost reports, capital
planning
Federal & State Regulations 28 CMS CoP, F-Tags, survey process, 17.5%
licensure, OSHA, ADA, compliance
programs, regulatory standards
,Examination Questions
Domain 1: Resident Care & Quality of Life (Q1–Q40)
Q1. A nursing home administrator receives a complaint from a resident who states
that staff entered her room without knocking and opened her personal drawer
while she was in the bathroom. Under 42 CFR 483.10, which resident right is most
directly implicated in this situation?
A) The right to be free from abuse, neglect, and exploitation
B) The right to privacy and confidentiality of personal and clinical records
[Correct]
C) The right to dignity and respect in the provision of care and services
D) The right to choose a personal physician and to be fully informed about medical care
Correct Answer: B
Rationale: 42 CFR 483.10(c) guarantees each resident the right to personal privacy, which
includes the right to have personal mail, telephone conversations, and visits be treated as
confidential. Staff entering a room unannounced and accessing a resident's personal belongings
without permission is a direct violation of the resident's right to privacy. While dignity (C) is a
related concern, the specific act of accessing personal property without consent most directly
implicates the privacy right. The administrator must ensure that policies are in place and staff
are trained on knock-and-wait procedures and respecting residents' personal spaces.
Why Wrong: A is incorrect because Abuse, neglect, and exploitation (42 CFR 483.10(b))
involve more egregious acts of harm or financial misconduct. Unauthorized room entry, while a
rights violation, does not rise to the level of abuse or neglect in this context. | C is incorrect
because Dignity and respect (42 CFR 483.10(a)) is a broader right that encompasses courteous
treatment. While this situation may affect dignity, the specific act of accessing a personal
drawer is more precisely a privacy violation. | D is incorrect because The right to choose a
physician and be informed (42 CFR 483.10(d)) relates to medical decision-making autonomy,
which is unrelated to the scenario described.
Reference: 42 CFR 483.10(c); NAB Core of Knowledge Domain 1: Resident Rights
────────────────────────────────────────────────────────────
Q2. A nursing home administrator is reviewing the facility's person-centered care
approach. Which of the following actions by the administrator best demonstrates
commitment to person-centered care according to CMS regulatory standards?
A) Ensuring all care plans are completed within 14 days of admission and filed in the medical
record
B) Implementing a system where residents choose their own wake-up times,
meal schedules, and daily routines [Correct]
C) Assigning each resident a primary nurse who is responsible for all clinical decisions on the
care team
D) Requiring all staff to sign an acknowledgment form confirming they have read the person-
centered care policy
Correct Answer: B
Rationale: Person-centered care, as defined under 42 CFR 483.21, requires that each resident
receives care that honors their individual preferences, values, and needs. Allowing residents to
choose their own wake-up times, meal schedules, and daily routines directly reflects the
principles of person-centered care by giving residents control over their daily lives. This
approach moves away from institution-centered scheduling toward individualized routines. The
administrator's role is to establish systems and empower staff to support these choices while
maintaining safe care delivery.
Why Wrong: A is incorrect because Completing care plans within the regulatory timeframe is
a compliance requirement but does not inherently reflect person-centered care. A care plan can
be completed on time yet still reflect an institutional rather than individualized approach. | C is
incorrect because Assigning a primary nurse is a care delivery model decision but does not
, guarantee person-centered care. Person-centered care requires input from the resident and
interdisciplinary team, not just assignment of a single clinician. | D is incorrect because Having
staff sign an acknowledgment form is a documentation exercise that does not translate into
actual behavioral change or person-centered care delivery. It demonstrates compliance with a
policy requirement, not the implementation of person-centered principles.
Reference: 42 CFR 483.21; CMS SOM Appendix PP, F-Tag 655; NAB Core of Knowledge Domain
1
────────────────────────────────────────────────────────────
Q3. A nursing home administrator is analyzing the facility's Quality Measure (QM)
report and identifies that the facility's percentile for "Percent of Residents with
Falls" is at the 90th percentile. Which action should the administrator take first?
A) Terminate the director of nursing for failing to maintain adequate fall prevention
protocols
B) Convene the Quality Assurance and Performance Improvement (QAPI)
committee to conduct a root cause analysis [Correct]
C) Immediately report the high fall rate to the state survey agency as a condition of
participation deficiency
D) Increase staffing ratios on all shifts by adding two nursing assistants per floor
Correct Answer: B
Rationale: A QM at the 90th percentile means the facility is performing worse than 90% of
nursing homes nationally on falls. The appropriate administrative response is to use the
facility's QAPI process to conduct a systematic root cause analysis. QAPI, required under 42
CFR 483.75, is the framework through which facilities identify, analyze, and improve quality
concerns. The administrator should lead the QAPI committee in reviewing fall data, identifying
contributing factors, and developing targeted interventions. This systematic approach
addresses the root causes rather than applying superficial fixes.
Why Wrong: A is incorrect because Terminating a department head without first conducting a
thorough analysis is not appropriate leadership. The administrator must understand the
systemic factors contributing to falls before assigning individual accountability. | C is incorrect
because A high QM percentile is not an immediate jeopardy situation that requires self-
reporting to the state. It does indicate a need for focused improvement, but it is addressed
internally through QAPI before any external reporting would be considered. | D is incorrect
because Increasing staffing ratios without data analysis may not address the actual causes of
falls and is not a targeted intervention. Falls can result from environmental factors, medication
side effects, clinical conditions, and other causes that additional staff alone may not mitigate.
Reference: 42 CFR 483.75; CMS Quality Measures; NAB Core of Knowledge Domain 1: Quality
Assurance and Performance Improvement
────────────────────────────────────────────────────────────
Q4. Under 42 CFR 483.10, which of the following are guaranteed resident rights?
(Select all that apply)
A) The right to be free from physical restraints that are not required to treat the
resident's medical symptoms [Correct]
B) The right to participate in planning care and treatment or changes in care
and treatment [Correct]
C) The right to have the facility refuse to admit a resident whose care needs exceed the
facility's capabilities
D) The right to be fully informed, in language that the resident understands, of
his or her total health status [Correct]
Correct Answer: A, B, D
Rationale: 42 CFR 483.10 enumerates specific resident rights. Option A reflects 42 CFR
483.10(a)(2), which guarantees freedom from unnecessary physical restraints. Option B reflects
42 CFR 483.10(e)(1), which ensures the right to participate in care planning. Option D reflects
