NAB CORE ACTUAL EXAM 2026/2027 Complete
Questions and Answers Detailed Rationales Pass
Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Resident Care and Quality of Life | Q1 – Q10
Section 2 | Human Resources and Staff Development | Q11 – Q20
Section 3 | Finance, Reimbursement, and Business Operations | Q21 – Q30
Section 4 | Environment, Safety, and Physical Plant | Q31 – Q40
Section 5 | Laws, Regulations, and Ethics | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: RESIDENT CARE AND QUALITY OF LIFE Q1 – Q10
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Question 1 of 50
A 78-year-old female resident with moderate-stage dementia has been refusing meals
for three days and becoming increasingly agitated during bathing. Her family reports
she was a professional pianist and loved music. The interdisciplinary team meets to
address her declining intake and behavioral symptoms.
A. Initiate a psychoactive medication regimen to control agitation and improve
cooperation with care
B. Schedule a music therapy assessment and offer finger foods during preferred music
sessions
C. Place the resident on a 1:1 observation protocol for safety and document refusal of
care
D. Transfer the resident to a secured memory care unit for more intensive behavioral
management
Correct Answer: B
,Rationale: Person-centered care for dementia emphasizes identifying and leveraging
retained strengths and preferences, such as music, to address behavioral and nutritional
needs without relying on chemical restraints. Psychoactive medications can increase
fall risk and mortality in older adults with dementia and should not be first-line.
One-to-one observation and transfer to a secured unit do not address the root cause of
distress and may further disorient the resident.
Question 2 of 50
A 62-year-old male resident post-stroke with left hemiparesis is being evaluated for
discharge to a lower level of care. His MDS shows he requires extensive assistance with
transfers and moderate assistance with eating. The social worker notes his spouse
works full-time and their home has stairs at every entrance.
A. Discharge the resident home with 24-hour private duty nursing to support his spouse
B. Recommend short-term rehabilitation followed by reassessment for assisted living
placement
C. Arrange for a home safety evaluation and referral to a Medicaid waiver program for
home modifications
D. Transfer the resident to a long-term care facility indefinitely due to his functional
limitations
Correct Answer: C
Rationale: A home safety evaluation identifies specific environmental barriers, and
Medicaid waiver programs can fund necessary modifications like ramps, supporting the
resident's goal of returning home safely. Private duty nursing is often cost-prohibitive
and not a sustainable discharge plan. Short-term rehabilitation may be appropriate but
does not address the home environment barriers, and indefinite placement in a facility
disregards the resident's preference and least-restrictive setting principles.
Question 3 of 50
,A 84-year-old male resident with end-stage COPD is enrolled in hospice and has a
POLST indicating comfort measures only. His daughter, who lives out of state, calls
demanding that the facility transfer him to the hospital for a chest x-ray and IV
antibiotics for a suspected pneumonia.
A. Honor the daughter's request and arrange emergent transport to the hospital for
evaluation
B. Convene a family care conference with the hospice team to review the POLST and
goals of care
C. Refuse the daughter's request and inform her that the facility will not discuss the
matter further
D. Ask the attending physician to change the POLST to full treatment without consulting
the resident
Correct Answer: B
Rationale: When family members challenge established advance directives, a facilitated
care conference allows education about the POLST, exploration of concerns, and
reaffirmation of the resident's documented wishes. Transporting a comfort-measures
patient to the hospital contradicts the care plan and causes unnecessary distress.
Refusing to discuss the matter damages family relationships and trust, and altering a
POLST without resident input violates autonomy and informed consent.
Question 4 of 50
The facility's quarterly quality indicator report shows a 22% rate of antipsychotic use
among residents without a diagnosed psychotic disorder, well above the state average
of 12%. The administrator is asked to present an improvement plan to the corporate
office.
A. Implement a gradual dose reduction protocol for all residents on antipsychotics and
monitor for behavioral changes
B. Increase nursing documentation requirements to justify continued antipsychotic
prescribing to medical staff
, C. Mandate that physicians discontinue all antipsychotics within 30 days regardless of
individual risk assessment
D. Hire a consultant pharmacist to review each antipsychotic order and approve
renewals
Correct Answer: A
Rationale: CMS and state surveyors expect facilities to conduct gradual dose reductions
as part of a person-centered behavioral intervention plan, which is the evidence-based
approach to reducing unnecessary antipsychotic use. Increasing documentation does
not reduce prescribing and may create a false sense of compliance. A blanket
discontinuation mandate ignores individual clinical needs and risks severe withdrawal
or behavioral crisis. Consultant pharmacist review is valuable but does not replace the
facility's responsibility to implement systematic reduction protocols.
Question 5 of 50
A 91-year-old female resident with advanced Parkinson disease has developed a Stage
3 pressure injury on her sacrum. She spends most of the day in a geri-chair and is
incontinent of urine and stool. Her Braden score is 12.
A. Place the resident on a 2-hour turning schedule and apply a moisture barrier ointment
with each incontinent episode
B. Order a low-air-loss mattress and initiate a pressure injury prevention protocol with a
repositioning schedule
C. Consult wound care for debridement and begin negative pressure wound therapy on
the sacral wound
D. Restrict the resident to bed rest to eliminate pressure on the sacrum until the wound
heals
Correct Answer: B
Rationale: A Braden score of 12 indicates high risk, and a Stage 3 pressure injury
requires both offloading with a specialized mattress and a systematic prevention
protocol to address the root causes of immobility and incontinence. Turning schedules
Questions and Answers Detailed Rationales Pass
Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Resident Care and Quality of Life | Q1 – Q10
Section 2 | Human Resources and Staff Development | Q11 – Q20
Section 3 | Finance, Reimbursement, and Business Operations | Q21 – Q30
Section 4 | Environment, Safety, and Physical Plant | Q31 – Q40
Section 5 | Laws, Regulations, and Ethics | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: RESIDENT CARE AND QUALITY OF LIFE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 78-year-old female resident with moderate-stage dementia has been refusing meals
for three days and becoming increasingly agitated during bathing. Her family reports
she was a professional pianist and loved music. The interdisciplinary team meets to
address her declining intake and behavioral symptoms.
A. Initiate a psychoactive medication regimen to control agitation and improve
cooperation with care
B. Schedule a music therapy assessment and offer finger foods during preferred music
sessions
C. Place the resident on a 1:1 observation protocol for safety and document refusal of
care
D. Transfer the resident to a secured memory care unit for more intensive behavioral
management
Correct Answer: B
,Rationale: Person-centered care for dementia emphasizes identifying and leveraging
retained strengths and preferences, such as music, to address behavioral and nutritional
needs without relying on chemical restraints. Psychoactive medications can increase
fall risk and mortality in older adults with dementia and should not be first-line.
One-to-one observation and transfer to a secured unit do not address the root cause of
distress and may further disorient the resident.
Question 2 of 50
A 62-year-old male resident post-stroke with left hemiparesis is being evaluated for
discharge to a lower level of care. His MDS shows he requires extensive assistance with
transfers and moderate assistance with eating. The social worker notes his spouse
works full-time and their home has stairs at every entrance.
A. Discharge the resident home with 24-hour private duty nursing to support his spouse
B. Recommend short-term rehabilitation followed by reassessment for assisted living
placement
C. Arrange for a home safety evaluation and referral to a Medicaid waiver program for
home modifications
D. Transfer the resident to a long-term care facility indefinitely due to his functional
limitations
Correct Answer: C
Rationale: A home safety evaluation identifies specific environmental barriers, and
Medicaid waiver programs can fund necessary modifications like ramps, supporting the
resident's goal of returning home safely. Private duty nursing is often cost-prohibitive
and not a sustainable discharge plan. Short-term rehabilitation may be appropriate but
does not address the home environment barriers, and indefinite placement in a facility
disregards the resident's preference and least-restrictive setting principles.
Question 3 of 50
,A 84-year-old male resident with end-stage COPD is enrolled in hospice and has a
POLST indicating comfort measures only. His daughter, who lives out of state, calls
demanding that the facility transfer him to the hospital for a chest x-ray and IV
antibiotics for a suspected pneumonia.
A. Honor the daughter's request and arrange emergent transport to the hospital for
evaluation
B. Convene a family care conference with the hospice team to review the POLST and
goals of care
C. Refuse the daughter's request and inform her that the facility will not discuss the
matter further
D. Ask the attending physician to change the POLST to full treatment without consulting
the resident
Correct Answer: B
Rationale: When family members challenge established advance directives, a facilitated
care conference allows education about the POLST, exploration of concerns, and
reaffirmation of the resident's documented wishes. Transporting a comfort-measures
patient to the hospital contradicts the care plan and causes unnecessary distress.
Refusing to discuss the matter damages family relationships and trust, and altering a
POLST without resident input violates autonomy and informed consent.
Question 4 of 50
The facility's quarterly quality indicator report shows a 22% rate of antipsychotic use
among residents without a diagnosed psychotic disorder, well above the state average
of 12%. The administrator is asked to present an improvement plan to the corporate
office.
A. Implement a gradual dose reduction protocol for all residents on antipsychotics and
monitor for behavioral changes
B. Increase nursing documentation requirements to justify continued antipsychotic
prescribing to medical staff
, C. Mandate that physicians discontinue all antipsychotics within 30 days regardless of
individual risk assessment
D. Hire a consultant pharmacist to review each antipsychotic order and approve
renewals
Correct Answer: A
Rationale: CMS and state surveyors expect facilities to conduct gradual dose reductions
as part of a person-centered behavioral intervention plan, which is the evidence-based
approach to reducing unnecessary antipsychotic use. Increasing documentation does
not reduce prescribing and may create a false sense of compliance. A blanket
discontinuation mandate ignores individual clinical needs and risks severe withdrawal
or behavioral crisis. Consultant pharmacist review is valuable but does not replace the
facility's responsibility to implement systematic reduction protocols.
Question 5 of 50
A 91-year-old female resident with advanced Parkinson disease has developed a Stage
3 pressure injury on her sacrum. She spends most of the day in a geri-chair and is
incontinent of urine and stool. Her Braden score is 12.
A. Place the resident on a 2-hour turning schedule and apply a moisture barrier ointment
with each incontinent episode
B. Order a low-air-loss mattress and initiate a pressure injury prevention protocol with a
repositioning schedule
C. Consult wound care for debridement and begin negative pressure wound therapy on
the sacral wound
D. Restrict the resident to bed rest to eliminate pressure on the sacrum until the wound
heals
Correct Answer: B
Rationale: A Braden score of 12 indicates high risk, and a Stage 3 pressure injury
requires both offloading with a specialized mattress and a systematic prevention
protocol to address the root causes of immobility and incontinence. Turning schedules
