NAB Core of Knowledge, Long-Term Care Management &
CMS Regulations Exam Prep Document | 2026/2027 Edition |
250 Verified Questions
Federal Nursing Home Administrator Exam 2026-2027 QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% Verified Solutions | Updated Per Latest CMS Guidelines |
Graded A+
This comprehensive exam prep document is designed for candidates preparing for the Federal Nursing
Home Administrator (NHA) exam, covering the NAB Core of Knowledge, long-term care
management, and CMS regulations. It includes 250 verified questions with detailed rationales to
reinforce understanding and application of key concepts. The content is aligned with the 2026/2027
academic year and reflects the latest federal guidelines and industry standards. Ideal for self-study or as
a supplement to formal coursework, this resource ensures thorough preparation for exam success.
Key Features:
NAB Core of Knowledge domains including resident care, management, and leadership
Long-term care administration principles and best practices
CMS regulations and compliance requirements for nursing facilities
Quality assurance and performance improvement (QAPI) frameworks
Financial management and reimbursement systems (Medicare/Medicaid)
Ethical and legal considerations in long-term care
Updates for 2026:
- Updated to reflect 2026/2027 CMS regulatory changes and survey protocols
- Incorporated new NAB exam content outline revisions
- Added questions on emerging topics like infection control and emergency preparedness
- Revised rationales to include recent federal guidance and court rulings
- Enhanced distractor explanations to clarify common misconceptions
Abstract:
This exam preparation document provides a rigorous review of the Federal Nursing Home Administrator (NHA)
exam, focusing on the NAB Core of Knowledge, long-term care management, and CMS regulations. The 250
verified questions are organized into content areas that mirror the exam blueprint, ensuring comprehensive
coverage of resident care, human resources, financial management, physical environment, and leadership. Each
question includes a detailed rationale explaining the correct answer and why the distractors are incorrect,
promoting deep learning and retention. The content is updated for the 2026/2027 academic year, incorporating the
latest CMS guidelines, survey processes, and quality improvement initiatives. This resource is essential for
candidates seeking to demonstrate mastery of the knowledge required to manage nursing facilities effectively and
ethically. By engaging with these questions, learners will develop critical thinking skills and the ability to apply
regulations to real-world scenarios, ultimately enhancing their readiness for the licensure exam.
Keywords:
Nursing Home Administrator exam, NAB Core of Knowledge, Long-term care management, CMS regulations,
Federal NHA prep, 2026-2027 exam guide, 250 questions with rationales, Licensure exam preparation
Answer Format:
Each question is followed by a detailed rationale that explains the correct answer and provides a thorough analysis
of why each distractor is incorrect. The rationales reference specific regulations, best practices, and clinical
guidelines to reinforce learning and application.
Page 1
,Compliance Checklist:
Aligned with NAB Core of Knowledge domains and exam blueprint
Updated per 2026/2027 CMS regulatory requirements
Includes QAPI, infection control, and emergency preparedness topics
Rationales cite authoritative sources (e.g., CMS, OBRA, AHCA/NCAL)
Distractor explanations address common errors and misconceptions
Suitable for self-study and group review sessions
Content Area Overview:
Content Area Questions Key Topics Weight
Resident Care Management and 1-50 Person-centered care, clinical care standards, 20%
Quality pain management, dementia care, falls
prevention
Human Resources and 51-100 Staffing requirements, training, performance 20%
Leadership management, labor laws, leadership styles
Financial Management and 101-140 Medicare/Medicaid, cost reporting, 16%
Reimbursement budgeting, billing, fraud and abuse
Physical Environment and 141-180 Life safety code, emergency preparedness, 16%
Safety infection control, environmental rounds
Regulatory Compliance and 181-220 CMS survey process, OBRA requirements, 16%
Governance resident rights, ethics, legal issues
Leadership and Strategic 221-250 Organizational culture, change management, 12%
Management marketing, community relations, QAPI
Page 2
,Q1. A nursing home administrator receives a report that a resident with a stage 2 pressure injury developed
a urinary tract infection (UTI) and was transferred to the hospital without a discharge summary. The
facility's QAPI committee reviewed the incident and identified that the nursing staff failed to implement the
care plan for turning and repositioning. Under the CMS Requirements for Participation, which of the
following actions is most critical for the administrator to take to prevent future adverse events?
A. Discipline the nursing staff involved to demonstrate accountability
B. Update the facility's policy on transfer documentation to include a checklist
C. Conduct a root cause analysis and implement a system-level change in the QAPI program
D. Send a memo to all staff reminding them of the importance of following care plans
Correct Answer: C. Conduct a root cause analysis and implement a system-level change in the QAPI
program
Rationale: The CMS QAPI regulation requires facilities to conduct thorough root cause analyses of adverse events
and implement system-level improvements. Disciplining staff (A) or sending a memo (D) are superficial responses
that do not address systemic failures. Updating transfer documentation (B) is important but does not prevent the
pressure injury or UTI recurrence.
Why Wrong:
A - Discipline focuses on individual blame rather than system improvement, which is contrary to QAPI
principles.
B - Updating transfer documentation addresses the hospital transfer issue but not the root cause of the
pressure injury.
D - A memo is insufficient to change staff behavior and does not meet the regulatory requirement for a
corrective action plan.
Reference: CMS State Operations Manual, Appendix PP - F865 QAPI
Q2. A facility's annual financial audit reveals that the previous year's Medicare cost report contained a
significant error in the allocation of nursing salaries to the skilled nursing facility (SNF) versus the nursing
facility (NF) cost centers. The error resulted in an overpayment from Medicare. The administrator is
informed that the error was due to a flawed allocation methodology that has been in place for three years.
Under the False Claims Act (FCA), which of the following is the most appropriate immediate action?
A. Correct the error in the current year's cost report and implement a new allocation method going forward
B. Voluntarily disclose the overpayment to Medicare and repay the amount with interest within 60 days
C. Adjust future cost reports to recoup the overpayment without notifying Medicare
D. Conduct an internal investigation and consult with legal counsel before making any disclosure
Correct Answer: B. Voluntarily disclose the overpayment to Medicare and repay the amount with interest
within 60 days
Rationale: Under the FCA and the 60-day repayment rule, providers must report and return overpayments by the
later of 60 days after identification or the date the corresponding cost report is due. Voluntary disclosure
demonstrates good faith and reduces penalties. Correcting only future reports (A) or adjusting future reports (C)
does not address the past overpayment. While consulting legal counsel (D) is prudent, delaying beyond 60 days
could trigger FCA liability.
Why Wrong:
A - Correcting only future reports does not address the past overpayment and may still result in FCA liability.
C - Adjusting future reports without disclosure is fraudulent and violates the FCA.
D - While consultation is wise, delaying disclosure beyond 60 days after identification risks FCA penalties.
Reference: Patient Protection and Affordable Care Act § 6402; 42 U.S.C. § 1320a-7k(d)
Page 3
, Q3. A nursing home administrator is reviewing the facility's quality measures (QMs) for the past quarter.
The data show that the percentage of long-stay residents with a urinary catheter inserted and left in place has
increased from 5% to 12%. The national average is 3%. The administrator knows that catheter use is
associated with increased risk of UTIs and other complications. Which of the following interventions is most
likely to reduce catheter use while maintaining resident safety?
A. Implement a policy requiring a physician order for any catheter insertion with automatic renewal every 30 days
B. Conduct a weekly bladder ultrasound for all residents with catheters to assess for bladder distention
C. Establish a nurse-driven protocol for catheter removal and use of external collection devices for appropriate residents
D. Increase the frequency of catheter changes to every two weeks to reduce infection risk
Correct Answer: C. Establish a nurse-driven protocol for catheter removal and use of external collection devices for
appropriate residents
Rationale: Nurse-driven protocols that allow removal of catheters without a physician order (unless contraindicated) are
evidence-based and reduce unnecessary catheter use. External collection devices (e.g., condom catheters in males) can be
appropriate alternatives. Requiring a physician order (A) may create a barrier to removal but does not actively promote
removal. Bladder ultrasound (B) does not address catheter removal. More frequent catheter changes (D) increase cost and
trauma without reducing infection.
Why Wrong:
A - This policy may actually increase catheter use if physicians routinely renew orders without reassessment.
B - Bladder ultrasound is a diagnostic tool, not an intervention to reduce catheter use.
D - Frequent changes increase the risk of trauma and infection, and do not address the underlying indication for
catheterization.
Reference: Centers for Disease Control and Prevention (CDC) Catheter-Associated Urinary Tract Infection (CAUTI)
Prevention Guidelines
Q4. A resident with advanced dementia has a feeding tube placed due to dysphagia. The interdisciplinary
team, including the resident's family, agrees that the feeding tube is for comfort and to prevent aspiration.
The resident's advance directive states a preference for no artificial nutrition. The family now requests
removal of the feeding tube, but the attending physician refuses, stating it would be unethical. The
administrator must decide the best course of action. Which of the following is the most appropriate step?
A. Support the physician's decision and keep the feeding tube in place to avoid legal risk
B. Request an ethics committee review and, if consistent with the advance directive, facilitate removal of the
feeding tube
C. Transfer the resident to another facility that will honor the advance directive
D. Advise the family to obtain a court order to override the physician's refusal
Correct Answer: B. Request an ethics committee review and, if consistent with the advance directive,
facilitate removal of the feeding tube
Rationale: The resident's advance directive is legally binding under the Patient Self-Determination Act. The facility
must respect the directive. An ethics committee review can clarify the situation and support the family's request.
Keeping the tube (A) violates the advance directive. Transferring (C) may be disruptive and delay care. A court
order (D) is costly and time-consuming; the facility should first attempt to resolve the conflict internally.
Why Wrong:
A - Ignoring the advance directive violates federal law and the resident's rights.
C - Transfer is not necessary if the facility can resolve the conflict internally; it may also cause distress.
D - A court order is a last resort; the facility should first use its own ethics process.
Reference: Patient Self-Determination Act, 42 U.S.C. § 1395cc(f); CMS F-tag F578
Page 4
CMS Regulations Exam Prep Document | 2026/2027 Edition |
250 Verified Questions
Federal Nursing Home Administrator Exam 2026-2027 QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% Verified Solutions | Updated Per Latest CMS Guidelines |
Graded A+
This comprehensive exam prep document is designed for candidates preparing for the Federal Nursing
Home Administrator (NHA) exam, covering the NAB Core of Knowledge, long-term care
management, and CMS regulations. It includes 250 verified questions with detailed rationales to
reinforce understanding and application of key concepts. The content is aligned with the 2026/2027
academic year and reflects the latest federal guidelines and industry standards. Ideal for self-study or as
a supplement to formal coursework, this resource ensures thorough preparation for exam success.
Key Features:
NAB Core of Knowledge domains including resident care, management, and leadership
Long-term care administration principles and best practices
CMS regulations and compliance requirements for nursing facilities
Quality assurance and performance improvement (QAPI) frameworks
Financial management and reimbursement systems (Medicare/Medicaid)
Ethical and legal considerations in long-term care
Updates for 2026:
- Updated to reflect 2026/2027 CMS regulatory changes and survey protocols
- Incorporated new NAB exam content outline revisions
- Added questions on emerging topics like infection control and emergency preparedness
- Revised rationales to include recent federal guidance and court rulings
- Enhanced distractor explanations to clarify common misconceptions
Abstract:
This exam preparation document provides a rigorous review of the Federal Nursing Home Administrator (NHA)
exam, focusing on the NAB Core of Knowledge, long-term care management, and CMS regulations. The 250
verified questions are organized into content areas that mirror the exam blueprint, ensuring comprehensive
coverage of resident care, human resources, financial management, physical environment, and leadership. Each
question includes a detailed rationale explaining the correct answer and why the distractors are incorrect,
promoting deep learning and retention. The content is updated for the 2026/2027 academic year, incorporating the
latest CMS guidelines, survey processes, and quality improvement initiatives. This resource is essential for
candidates seeking to demonstrate mastery of the knowledge required to manage nursing facilities effectively and
ethically. By engaging with these questions, learners will develop critical thinking skills and the ability to apply
regulations to real-world scenarios, ultimately enhancing their readiness for the licensure exam.
Keywords:
Nursing Home Administrator exam, NAB Core of Knowledge, Long-term care management, CMS regulations,
Federal NHA prep, 2026-2027 exam guide, 250 questions with rationales, Licensure exam preparation
Answer Format:
Each question is followed by a detailed rationale that explains the correct answer and provides a thorough analysis
of why each distractor is incorrect. The rationales reference specific regulations, best practices, and clinical
guidelines to reinforce learning and application.
Page 1
,Compliance Checklist:
Aligned with NAB Core of Knowledge domains and exam blueprint
Updated per 2026/2027 CMS regulatory requirements
Includes QAPI, infection control, and emergency preparedness topics
Rationales cite authoritative sources (e.g., CMS, OBRA, AHCA/NCAL)
Distractor explanations address common errors and misconceptions
Suitable for self-study and group review sessions
Content Area Overview:
Content Area Questions Key Topics Weight
Resident Care Management and 1-50 Person-centered care, clinical care standards, 20%
Quality pain management, dementia care, falls
prevention
Human Resources and 51-100 Staffing requirements, training, performance 20%
Leadership management, labor laws, leadership styles
Financial Management and 101-140 Medicare/Medicaid, cost reporting, 16%
Reimbursement budgeting, billing, fraud and abuse
Physical Environment and 141-180 Life safety code, emergency preparedness, 16%
Safety infection control, environmental rounds
Regulatory Compliance and 181-220 CMS survey process, OBRA requirements, 16%
Governance resident rights, ethics, legal issues
Leadership and Strategic 221-250 Organizational culture, change management, 12%
Management marketing, community relations, QAPI
Page 2
,Q1. A nursing home administrator receives a report that a resident with a stage 2 pressure injury developed
a urinary tract infection (UTI) and was transferred to the hospital without a discharge summary. The
facility's QAPI committee reviewed the incident and identified that the nursing staff failed to implement the
care plan for turning and repositioning. Under the CMS Requirements for Participation, which of the
following actions is most critical for the administrator to take to prevent future adverse events?
A. Discipline the nursing staff involved to demonstrate accountability
B. Update the facility's policy on transfer documentation to include a checklist
C. Conduct a root cause analysis and implement a system-level change in the QAPI program
D. Send a memo to all staff reminding them of the importance of following care plans
Correct Answer: C. Conduct a root cause analysis and implement a system-level change in the QAPI
program
Rationale: The CMS QAPI regulation requires facilities to conduct thorough root cause analyses of adverse events
and implement system-level improvements. Disciplining staff (A) or sending a memo (D) are superficial responses
that do not address systemic failures. Updating transfer documentation (B) is important but does not prevent the
pressure injury or UTI recurrence.
Why Wrong:
A - Discipline focuses on individual blame rather than system improvement, which is contrary to QAPI
principles.
B - Updating transfer documentation addresses the hospital transfer issue but not the root cause of the
pressure injury.
D - A memo is insufficient to change staff behavior and does not meet the regulatory requirement for a
corrective action plan.
Reference: CMS State Operations Manual, Appendix PP - F865 QAPI
Q2. A facility's annual financial audit reveals that the previous year's Medicare cost report contained a
significant error in the allocation of nursing salaries to the skilled nursing facility (SNF) versus the nursing
facility (NF) cost centers. The error resulted in an overpayment from Medicare. The administrator is
informed that the error was due to a flawed allocation methodology that has been in place for three years.
Under the False Claims Act (FCA), which of the following is the most appropriate immediate action?
A. Correct the error in the current year's cost report and implement a new allocation method going forward
B. Voluntarily disclose the overpayment to Medicare and repay the amount with interest within 60 days
C. Adjust future cost reports to recoup the overpayment without notifying Medicare
D. Conduct an internal investigation and consult with legal counsel before making any disclosure
Correct Answer: B. Voluntarily disclose the overpayment to Medicare and repay the amount with interest
within 60 days
Rationale: Under the FCA and the 60-day repayment rule, providers must report and return overpayments by the
later of 60 days after identification or the date the corresponding cost report is due. Voluntary disclosure
demonstrates good faith and reduces penalties. Correcting only future reports (A) or adjusting future reports (C)
does not address the past overpayment. While consulting legal counsel (D) is prudent, delaying beyond 60 days
could trigger FCA liability.
Why Wrong:
A - Correcting only future reports does not address the past overpayment and may still result in FCA liability.
C - Adjusting future reports without disclosure is fraudulent and violates the FCA.
D - While consultation is wise, delaying disclosure beyond 60 days after identification risks FCA penalties.
Reference: Patient Protection and Affordable Care Act § 6402; 42 U.S.C. § 1320a-7k(d)
Page 3
, Q3. A nursing home administrator is reviewing the facility's quality measures (QMs) for the past quarter.
The data show that the percentage of long-stay residents with a urinary catheter inserted and left in place has
increased from 5% to 12%. The national average is 3%. The administrator knows that catheter use is
associated with increased risk of UTIs and other complications. Which of the following interventions is most
likely to reduce catheter use while maintaining resident safety?
A. Implement a policy requiring a physician order for any catheter insertion with automatic renewal every 30 days
B. Conduct a weekly bladder ultrasound for all residents with catheters to assess for bladder distention
C. Establish a nurse-driven protocol for catheter removal and use of external collection devices for appropriate residents
D. Increase the frequency of catheter changes to every two weeks to reduce infection risk
Correct Answer: C. Establish a nurse-driven protocol for catheter removal and use of external collection devices for
appropriate residents
Rationale: Nurse-driven protocols that allow removal of catheters without a physician order (unless contraindicated) are
evidence-based and reduce unnecessary catheter use. External collection devices (e.g., condom catheters in males) can be
appropriate alternatives. Requiring a physician order (A) may create a barrier to removal but does not actively promote
removal. Bladder ultrasound (B) does not address catheter removal. More frequent catheter changes (D) increase cost and
trauma without reducing infection.
Why Wrong:
A - This policy may actually increase catheter use if physicians routinely renew orders without reassessment.
B - Bladder ultrasound is a diagnostic tool, not an intervention to reduce catheter use.
D - Frequent changes increase the risk of trauma and infection, and do not address the underlying indication for
catheterization.
Reference: Centers for Disease Control and Prevention (CDC) Catheter-Associated Urinary Tract Infection (CAUTI)
Prevention Guidelines
Q4. A resident with advanced dementia has a feeding tube placed due to dysphagia. The interdisciplinary
team, including the resident's family, agrees that the feeding tube is for comfort and to prevent aspiration.
The resident's advance directive states a preference for no artificial nutrition. The family now requests
removal of the feeding tube, but the attending physician refuses, stating it would be unethical. The
administrator must decide the best course of action. Which of the following is the most appropriate step?
A. Support the physician's decision and keep the feeding tube in place to avoid legal risk
B. Request an ethics committee review and, if consistent with the advance directive, facilitate removal of the
feeding tube
C. Transfer the resident to another facility that will honor the advance directive
D. Advise the family to obtain a court order to override the physician's refusal
Correct Answer: B. Request an ethics committee review and, if consistent with the advance directive,
facilitate removal of the feeding tube
Rationale: The resident's advance directive is legally binding under the Patient Self-Determination Act. The facility
must respect the directive. An ethics committee review can clarify the situation and support the family's request.
Keeping the tube (A) violates the advance directive. Transferring (C) may be disruptive and delay care. A court
order (D) is costly and time-consuming; the facility should first attempt to resolve the conflict internally.
Why Wrong:
A - Ignoring the advance directive violates federal law and the resident's rights.
C - Transfer is not necessary if the facility can resolve the conflict internally; it may also cause distress.
D - A court order is a last resort; the facility should first use its own ethics process.
Reference: Patient Self-Determination Act, 42 U.S.C. § 1395cc(f); CMS F-tag F578
Page 4
