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Quizzes > Health & Medicine

Nursing Home Administrator Practice Test

Quick, free quiz with realistic nursing home administrator exam questions. Instant results.

Editorial: Review CompletedCreated By: Rahul WaniUpdated Aug 25, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for NHA exam practice test quiz on a coral background

This nursing home administrator practice test helps you check your knowledge of regulations, resident care, budgeting, and leadership before the exam. Get quick feedback to see where you are strong and what to review. For more practice, try our free NHA practice test, this home health aide test, or a cmaa certification practice test.

Which federal law is primarily responsible for regulating nursing home care quality standards?
Omnibus Budget Reconciliation Act of 1987 (OBRA '87)
Affordable Care Act (ACA)
Social Security Act of 1935
Health Insurance Portability and Accountability Act (HIPAA)
The Omnibus Budget Reconciliation Act of 1987, commonly called OBRA '87, established federal requirements for nursing home staffing, resident rights, and quality of care. It set standards for resident assessments, care planning, and staff training. Facilities must comply with OBRA regulations to participate in Medicare and Medicaid programs.
Which regulation specifically protects the privacy of residents' medical information in nursing homes?
Emergency Medical Treatment and Active Labor Act (EMTALA)
Americans with Disabilities Act (ADA)
Fair Housing Act
Health Insurance Portability and Accountability Act (HIPAA)
HIPAA sets national standards for the protection of individually identifiable health information. Nursing homes are covered entities and must implement safeguards to ensure resident privacy. HIPAA requires secure handling, transmission, and storage of medical records.
Minimum Data Set (MDS) assessments in nursing homes are primarily used for which purpose?
Staff performance evaluations
Hospital discharge planning
Facility licensure inspections
Developing individualized care plans for residents
The MDS is part of the Resident Assessment Instrument used to identify resident strengths, needs, and preferences. Its main goal is to guide the development of personalized care plans. MDS data also drive quality measures and reimbursement.
Which staff member is primarily responsible for overseeing medication administration in a nursing home?
Medical Director
Registered Nurse (RN)
Certified Nursing Assistant (CNA)
Licensed Practical Nurse (LPN)
RNs assess residents' medication needs, monitor for adverse effects, and ensure safe administration. They supervise LPNs and CNAs in their medication-related tasks. Federal and state regulations require RN oversight of all medication processes.
What is the primary purpose of a resident care plan in a nursing home?
To track employee attendance
To guide and coordinate individualized resident care
To comply only with fire safety regulations
To provide marketing information to families
A care plan outlines resident-specific goals, interventions, and schedules. It ensures consistent, coordinated care among all team members. Care plans are reviewed and updated regularly based on resident assessments.
What does DPOA stand for in the context of resident decision-making?
Direct Patient Observation Agreement
Data Protection Oversight Act
Durable Power of Attorney
Department of Public Appeals
A Durable Power of Attorney authorizes a designated individual to make healthcare or financial decisions for a resident who is incapacitated. It remains in effect during incapacity. Facilities must document and honor valid DPOAs.
What does CMS stand for in the context of long-term care regulation?
Commission on Medical Safety
Care Management Standards
Council for Medicaid Surveyors
Centers for Medicare & Medicaid Services
CMS is the federal agency that administers the Medicare and Medicaid programs. It establishes regulations and survey processes for nursing home participation. CMS works with State Survey Agencies to enforce quality standards.
Which staff member typically provides daily personal care such as bathing and dressing?
Registered Nurse (RN)
Certified Nursing Assistant (CNA)
Licensed Practical Nurse (LPN)
Medical Director
CNAs provide the bulk of hands-on personal care, assisting with activities of daily living. They report changes in resident condition to nursing staff. Proper CNA staffing is essential for resident well-being.
OBRA '87 requires nursing homes to have how many consecutive hours of RN coverage per day?
24 consecutive hours
4 consecutive hours
8 consecutive hours
12 consecutive hours
OBRA '87 mandates at least 8 consecutive hours of RN coverage per day, seven days a week. During the remaining hours, an LPN or RN must be on duty. These requirements help ensure clinical oversight.
What is the first action to take if a resident elopes from a nursing home?
Notify the resident's family
Document the event and continue normal operations
Wait 10 minutes to see if the resident returns
Initiate the facility's elopement response plan and search immediately
Facilities must respond promptly to elopements by activating their elopement protocol. Immediate search efforts reduce risk of harm to the resident. Staff should follow established procedures and notify authorities if needed.
Which entity conducts nursing home surveys to enforce federal regulations?
Joint Commission
State Survey Agencies under contract with CMS
Centers for Disease Control and Prevention (CDC)
Occupational Safety and Health Administration (OSHA)
CMS contracts with State Survey Agencies to perform periodic and complaint surveys. These surveys assess compliance with federal requirements. Findings result in citations or enforcement actions if deficiencies are identified.
According to infection control guidelines, what is the minimum recommended time for handwashing?
5 seconds
30 seconds
10 seconds
20 seconds
The CDC recommends washing hands with soap and water for at least 20 seconds to effectively remove pathogens. Proper hand hygiene is key to preventing healthcare-associated infections. Staff should follow hand hygiene protocols before and after resident contact.
How often must a nursing home's Quality Assurance Performance Improvement (QAPI) committee meet at minimum?
Monthly
Annually
Weekly
Quarterly
CMS requires QAPI committees to meet at least quarterly to review quality data and implement improvements. Regular meetings support ongoing monitoring and corrective action. Documentation of committee activities must be maintained.
Suspected resident abuse in a nursing home must be reported to the State Survey Agency within what timeframe?
24 hours
One week
48 hours
Immediately upon discovery
Facilities must report suspected abuse to the State Survey Agency within 24 hours of identification. Immediate internal investigation and protective measures are also required. Failure to report timely can result in penalties.
Which type of diet is appropriate for a resident with significant swallowing difficulties (dysphagia)?
Renal diet
Mechanical soft diet
Pureed diet
Regular diet
A pureed diet ensures food is ground to a smooth consistency, reducing choking risk for dysphagia residents. Speech-language pathologists often recommend pureed textures after swallow evaluations. Diet modifications must be outlined in the care plan.
What is the most fundamental standard precaution to prevent infection transmission in nursing homes?
Sterilizing resident rooms daily
Proper handwashing
Use of gowns only
Air filtration only
Handwashing is the single most effective method to prevent the spread of infections. Standard precautions require hand hygiene before and after all resident interactions. Gloves and other barriers supplement hand hygiene when needed.
What is the primary purpose of the Minimum Data Set (MDS) in nursing homes?
To drive individualized care planning and quality measures
To determine facility licensure status
To schedule recreational activities
To evaluate staff performance
The MDS collects comprehensive resident data to inform care plans and to produce quality indicators. It is used for payment determination under Medicare and Medicaid. Facilities must complete MDS assessments at specified intervals.
Under HIPAA, how long must a nursing home retain documentation such as privacy policies and breach reports?
10 years
6 years
3 years
Indefinitely
HIPAA requires covered entities to retain required documentation for six years from the date of creation or last effective date. This includes privacy policies, breach notifications, and training records. Proper record retention demonstrates compliance.
By what date must long-term care facilities offer annual influenza vaccination to residents according to CMS guidelines?
October 31 of each year
December 31 of each year
November 15 of each year
September 1 of each year
CMS requires that eligible residents be offered influenza vaccine by October 31 annually. Early vaccination helps protect residents before flu season peaks. Facilities must document offers and refusals.
In the context of nursing home operations, 'neglect' is defined as:
A resident's refusal of care
Intentional physical harm to a resident
Failure to provide necessary goods and services that results in harm
Documentation errors in care planning
Neglect involves omissions rather than commissions and occurs when staff fail to provide adequate care. It can lead to physical or emotional harm. CMS requires facilities to address and prevent neglect.
Which tool is commonly used for root cause analysis in nursing home quality improvement?
Fishbone (Ishikawa) diagram
Kano model
SWOT analysis
Gantt chart
The Fishbone diagram helps teams visually map out potential causes of a problem. It categorizes factors to identify root causes. This tool is widely used in QAPI initiatives.
What is the primary role of the State Long-Term Care Ombudsman in nursing homes?
Set federal staffing standards
Advocate for residents and investigate complaints
Conduct fire safety inspections
Administer medication protocols
Ombudsmen serve as resident advocates, securing rights and resolving complaints. They are designated under the Older Americans Act. Facilities must allow ombudsman access to residents.
In long-term care reimbursement, what does the acronym RUG stand for?
Resource Utilization Group
Resident Usage Guide
Regional Utilization Gauge
Regulatory Usage Group
RUGs classify residents based on care needs to determine Medicare and Medicaid payment rates. The RUG system uses MDS data to assign case-mix categories. Proper coding ensures accurate reimbursement.
Which information must be included in nursing home resident council meeting minutes?
Action items with responsible parties and follow-up dates
Staff performance evaluations
Resident medical diagnoses
Personal financial details of residents
Minutes should document decisions, assigned tasks, and timelines to ensure accountability. Personal health or financial data is protected by privacy regulations. Maintaining clear records demonstrates compliance with resident rights requirements.
Within how many days after admission must a nursing home complete the initial MDS assessment?
14 days
7 days
30 days
3 days
CMS requires completion of the comprehensive MDS assessment within 14 days of admission. This ensures timely identification of resident needs and care planning. Interim assessments may be required for significant changes.
Which committee in a nursing home is primarily responsible for overseeing advance directives and ethical issues?
Ethics committee
Safety committee
Infection control committee
Quality assurance committee
The ethics committee guides policies on advance directives, end-of-life decisions, and moral dilemmas. It typically includes interdisciplinary representation. Residents and families can consult this committee.
Under OSHA's Bloodborne Pathogens Standard, how often must nursing home staff receive training?
Annually
Every six months
Every two years
Only at hire
OSHA requires annual refresher training to ensure staff remain current on exposure control plans. Training covers safe handling of sharps and bloodborne pathogens. Documentation of training is mandatory.
What is the main goal of a fire risk assessment in a nursing home?
Evaluate kitchen menu safety
Assess staff communication skills
Identify potential fire hazards and mitigation strategies
Determine resident satisfaction
Fire risk assessments examine building features, evacuation routes, and equipment. They help prioritize fire prevention and response improvements. Regular assessments support compliance with life safety codes.
Which three areas are included in the CMS Five-Star Quality Rating System for nursing homes?
Medication costs, occupancy rate, and staff turnover
Facility age, location, and ownership
Resident council activities, meal quality, and parking
Health inspections, staffing, and quality measures
CMS Five-Star ratings are based on health inspection results, staffing levels, and clinical quality measures. These components are publicly reported on Nursing Home Compare. They help consumers evaluate facility performance.
Which financial statement provides information on a nursing home's cash inflows and outflows?
Statement of cash flows
Income statement
Balance sheet
Budget variance report
The statement of cash flows details cash from operating, investing, and financing activities. It shows how cash is generated and used over a period. It complements the income statement and balance sheet.
Under Medicare Part A, how many days of skilled nursing facility care are covered per benefit period?
60 days
100 days
90 days
120 days
Medicare Part A covers up to 100 days of SNF care per benefit period after a qualifying hospital stay. Benefit periods reset after 60 consecutive days out of the facility. Costs apply beyond day 20 in the form of copayments.
Under the SNF Prospective Payment System, what case-mix classification system was used prior to PDPM?
Diagnosis-Related Groups (DRG)
Ambulatory Payment Classifications (APC)
Therapeutic Resource Groups (TRG)
Resource Utilization Groups (RUG-IV)
Before PDPM implementation in October 2019, the SNF PPS used RUG-IV to classify residents by resource needs. RUGs were based on MDS-driven therapy minutes and clinical complexity. RUG-IV grouped residents into payment categories.
What does the acronym PDPM stand for in Medicare reimbursement for skilled nursing facilities?
Prospective Diagnosis Payment Method
Patient-Directed Pricing Matrix
Post-Discharge Payment Management
Patient-Driven Payment Model
PDPM is the Medicare payment model effective October 2019 for SNFs. It classifies residents into case-mix adjusted categories across nursing, therapy, and ancillary components. PDPM focuses on clinical characteristics rather than therapy intensity.
Which accounting principle requires that expenses be recorded in the same period as the revenues they help generate?
Going concern principle
Matching principle
Revenue recognition principle
Cost principle
The matching principle ensures that costs associated with delivering services are recognized in the same period as related revenues. This gives an accurate picture of facility profitability. It is a cornerstone of accrual accounting.
After a resident experiences a significant change in status, within how many days must the nursing home complete a comprehensive reassessment?
14 days
30 days
21 days
7 days
CMS requires a comprehensive MDS reassessment within 14 days of a significant change in status. This ensures the care plan reflects current resident needs. Timely reassessment is critical for regulatory compliance.
What is the maximum daily civil money penalty (CMP) amount that CMS may impose for resident abuse?
$10,000 per day
$5,000 per day
$20,000 per day
$1,000 per day
CMS may impose CMPs up to $10,000 per day for abuse or neglect violations. The amount depends on the severity of harm and facility history. CMPs are an enforcement tool for serious deficiencies.
Which section of the MDS addresses swallowing disorders and nutritional requirements?
Section C
Section M
Section K
Section F
Section K covers swallowing disorders, nutritional approaches, and weight changes. Accurate coding in Section K informs care planning and reimbursement. Speech-language pathologists often contribute to this section.
Which committee is responsible for oversight of infection prevention and control in a nursing home?
Resident Council
Infection Prevention and Control Committee
Ethics Committee
Quality Assurance Committee
The Infection Prevention and Control Committee develops policies, reviews infection data, and implements control measures. It usually meets at least quarterly. Committee members include nursing, housekeeping, and medical staff.
What does QAPI stand for in nursing home quality improvement?
Qualified Administrative and Policy Initiative
Quality Assessment of Personnel Integrity
Quality Assurance and Policy Implementation
Quality Assurance and Performance Improvement
QAPI combines systematic data-driven approaches with performance improvement methods. It aims to continuously monitor and improve care processes. CMS mandates QAPI programs in all nursing homes.
Which legislation originally established the Medicare and Medicaid programs?
Affordable Care Act of 2010
Hill-Burton Act of 1946
Social Security Act of 1965
Omnibus Reconciliation Act of 1987
Title XVIII and XIX of the Social Security Act of 1965 created Medicare and Medicaid. These programs transformed healthcare financing for elderly and low-income populations. Nursing homes became major providers under these programs.
Which of the following is a required member of the interdisciplinary team (IDT) for MDS assessment?
Dietary Aide
Registered Nurse (RN)
Maintenance Supervisor
Medical Director only
Federal regulations require that the IDT include at least an RN, a physician, and a registered dietitian when conducting MDS assessments. Other staff like social workers and therapists may also participate. This ensures comprehensive evaluation.
Which type of federal survey is conducted without prior notice to the nursing home?
Certification survey
Renewal survey
Complaint survey
Validation survey
Complaint surveys are triggered by allegations of noncompliance and are unannounced to capture real-time facility conditions. Certification surveys can be scheduled but are often unannounced as well. Regular renewal surveys also may occur without notice.
How often should a nursing home conduct resident satisfaction surveys at minimum?
Quarterly
Bi-annually
Monthly
Annually
Annual resident satisfaction surveys help facilities gauge quality from the resident perspective. CMS encourages regular feedback mechanisms as part of QAPI. Surveys must be documented and used to drive improvements.
Under the SNF Prospective Payment System, outlier payments are triggered when case costs exceed what threshold?
Exact standard payment
1.5 times the standard payment
3.0 times the standard payment
2.5 times the standard payment
Outlier payments occur when a resident's allowable costs, adjusted for case mix, exceed 2.5 times the standard per diem rate. This protects facilities serving unusually costly cases. Facilities must submit cost reports to CMS.
Which federal rule governs the use of electronic health records and establishes security standards?
HIPAA Security Rule
ADA Title III
HITECH Act only
OBRA '87
The HIPAA Security Rule sets standards for protecting ePHI, including access controls and encryption. The HITECH Act strengthened these requirements and incentivized EHR adoption. Nursing homes must comply if they are covered entities.
Under the Medicare SNF Value-Based Purchasing program, what maximum percentage of payments is at risk based on rehospitalization performance?
10% of total Medicare SNF payments
2% of total Medicare SNF payments
1% of total Medicare SNF payments
5% of total Medicare SNF payments
The SNF VBP program withholds 2% of total Medicare payments and redistributes funds based on performance on rehospitalization measures. High-performing facilities can earn back more than the 2% withheld. This program aims to improve care transitions.
Which five case-mix adjusted components determine SNF payment rates under PDPM?
Medication, supplies, staffing, utilities, maintenance
Physical therapy, occupational therapy, speech-language pathology, nursing, non-therapy ancillary
Dietary, administrative, therapeutic recreation, nursing, housekeeping
Social work, dietary, therapy, medical director, activities
PDPM bases SNF Medicare payments on five case-mix components: PT, OT, SLP, nursing, and NTA. Each component has a case-mix index derived from MDS items. This model shifts focus to resident characteristics rather than therapy minutes.
In QAPI, what does the PDSA cycle stand for?
Plan-Do-Study-Act
Plan-Document-Set-Analyze
Prevent-Detect-Study-Act
Prepare-Develop-Survey-Assess
The PDSA cycle is a structured method for testing and implementing changes: plan an intervention, do it, study the results, and act on what is learned. It is fundamental to continuous quality improvement. Facilities use PDSA cycles within QAPI programs.
Which adverse event related to pressure ulcers must be reported as a serious event to CMS?
Stage 2 pressure ulcer present on admission
Stage 3 or 4 pressure ulcer acquired after admission
Stage 1 pressure ulcer acquired in facility
Any unstageable ulcer on admission
CMS requires reporting of any new pressure ulcers Stage 3 or 4 acquired in the facility after admission as serious events. These are considered potentially preventable and indicative of care deficiencies. Facilities must investigate and document corrective actions.
Which version of the Resident Assessment Instrument (RAI) is currently implemented in U.S. nursing homes?
RAI 2.0
RAI 5.0
RAI 3.0
RAI 4.0
RAI 3.0 is the standardized assessment tool used by CMS for long-term care facilities. It includes the MDS 3.0 and associated assessment protocols. RAI 4.0 is not implemented for nursing homes.
Which framework, known as the 'Triple Aim,' guides healthcare quality improvement efforts including QAPI?
Maximize occupancy, optimize staffing, minimize expenses
Improve patient experience, improve population health, reduce per capita costs
Standardize protocols, enforce compliance, penalize errors
Enhance staff satisfaction, increase revenue, expand services
The Triple Aim framework aims to enhance patient experience, improve overall population health, and reduce per capita healthcare costs. It underpins many quality initiatives including QAPI. Nursing homes apply Triple Aim principles to drive comprehensive improvements.
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Study Outcomes

  1. Understand NHA Exam Questions -

    Familiarize yourself with the structure and format of nha exam questions to navigate the official exam with confidence.

  2. Apply Key Concepts to Practice Scenarios -

    Solve realistic nursing home administrator exam questions covering regulatory compliance, resident care, and financial management.

  3. Identify Strengths and Gaps -

    Use this nursing home administrator practice test to pinpoint areas where you excel and topics that need further review.

  4. Enhance Time Management Skills -

    Simulate exam conditions with timed sections to improve pacing and reduce test-day anxiety.

  5. Develop Targeted Study Strategies -

    Create a personalized study plan based on your performance in the nursing home administrator exam study guide free practice questions.

  6. Evaluate Exam Readiness -

    Analyze your scores on nha exam sample questions to gauge preparedness and build confidence before test day.

Cheat Sheet

  1. OBRA Regulations & Resident Rights -

    The Omnibus Budget Reconciliation Act (OBRA) of 1987 (42 CFR 483) sets baseline standards for nursing home care, emphasizing resident dignity, choice, and self-determination. Use the mnemonic "DICE" (Dignity, Individualized care, Choice, Eviction protection) to recall core resident rights. Regularly review CMS guidance to ensure compliance with admission, transfer, and discharge protocols.

  2. Minimum Data Set (MDS) & Resident Assessment -

    The MDS is a standardized tool used in the RAI process to assess resident needs at admission, quarterly, and after status changes. Remember "RAI" as "Resident Assessment Inventory" and focus on Sections A - Z covering cognition, mood, ADLs, and more. Accurate MDS scoring directly impacts care planning and CMS quality measures.

  3. Quality Assurance & Performance Improvement (QAPI) -

    QAPI combines systematic data monitoring with the Plan-Do-Study-Act (PDSA) cycle to drive continuous improvement. Apply the PDSA mnemonic - Plan change, Do test, Study results, Act on lessons - to initiatives like fall reduction or pressure ulcer prevention. Refer to CMS's QAPI guidelines for evidence-based benchmarks and tools.

  4. Financial Management & Operating Ratios -

    Monitor the operating ratio (Operating Expenses ÷ Operating Revenue × 100) to gauge fiscal health; a ratio below 80% often indicates sound management. Break down expenses by labor, supplies, and overhead, then compare against industry norms from AHCA reports. Use spreadsheet templates to project budgets and perform variance analysis monthly.

  5. Infection Control & Safety Protocols -

    Adhere to Standard Precautions and WHO's "5 Moments for Hand Hygiene" (before/after resident contact, aseptic tasks, exposure risk, and environmental contact). Implement monthly audits and use visual reminders near hand-sanitizer stations to boost compliance. Stay current with CDC guidelines on PPE, isolation, and outbreak management.

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