Free NAB National Nursing Home Administrators Line of Service Exam (NHA) Practice Questions

Sample Practice Questions

Try these 10 sample questions from the NAB National Nursing Home Administrators Line of Service Exam (NHA) practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 90-bed skilled nursing facility is building its master nursing schedule and no State waiver of the nursing service requirements is in effect. What is the minimum registered nurse coverage the facility must provide under the federal nursing services requirement?

   1. A. The services of a registered nurse for at least 8 consecutive hours a day, 7 days a week
   2. B. The services of a registered nurse for at least 8 consecutive hours a day, 5 days a week
   3. C. The services of a registered nurse for at least 12 consecutive hours a day, 7 days a week
   4. D. The services of a registered nurse for at least 16 consecutive hours a day, 6 days a week

   Answer: A

   Explanation: Absent a waiver, 42 CFR 483.35(b)(1) sets the floor: "Except when waived under paragraph (e) or (f) of this section, the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week." The requirement is stated in consecutive hours per day across all seven days, so a schedule that leaves any day of the week without eight consecutive RN hours does not meet it, and the rule does not require twelve or sixteen hours.

   Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.35(b)(1)

2. 2A resident who had deposited personal funds with the facility dies. Under the federal resident rights requirement, what must the facility do with those funds?

   1. A. Convey the funds and a final accounting within 30 days to the individual or probate jurisdiction administering the resident's estate, in accordance with State law
   2. B. Convey the funds and a final accounting within 30 days to the person who served as the resident's representative during the stay
   3. C. Hold the funds until the estate is settled and then convey them with a final accounting to the estate's administrator
   4. D. Convey the funds within 60 days to the individual or probate jurisdiction administering the resident's estate, together with quarterly statements for the final year

   Answer: A

   Explanation: 42 CFR 483.10(f)(10)(v) requires that "Upon the discharge, eviction, or death of a resident with a personal fund deposited with the facility, the facility must convey within 30 days the resident's funds, and a final accounting of those funds, to the resident, or in the case of death, the individual or probate jurisdiction administering the resident's estate, in accordance with State law." Two elements decide this item: the 30-day deadline and the recipient on death, which is the estate's administrator or probate jurisdiction rather than the person who had acted as resident representative.

   Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.10(f)(10)(v)

3. 3A facility runs a large volunteer program and is defining the reach of its infection prevention and control program. Under the federal infection control requirement, which population must the program's system for preventing, identifying, reporting, investigating and controlling infections cover?

   1. A. All residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement
   2. B. All residents, staff, and those volunteers and contracted individuals who provide direct resident care
   3. C. All residents, staff, contracted service providers, and visitors who enter resident care areas of the facility
   4. D. All residents and staff, and all other individuals present in the facility during a declared outbreak period

   Answer: A

   Explanation: 42 CFR 483.80(a)(1) requires the infection prevention and control program to include "A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to 483.71 and following accepted national standards." Volunteers and visitors are named without qualification, so narrowing coverage to those in direct care roles, to care areas, or to outbreak periods falls short of the paragraph.

   Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.80(a)(1)

4. 4A director of nursing asks the administrator whether she may personally cover a charge nurse shift when a nurse calls out. Under the federal nursing services requirement, the director of nursing may serve as a charge nurse only when the facility's average daily occupancy is at or below what level?

   1. A. 60 or fewer residents
   2. B. 30 or fewer residents
   3. C. 100 or fewer residents
   4. D. 120 or fewer residents

   Answer: A

   Explanation: 42 CFR 483.35(b)(3) states that "The director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents." The test is the facility's average daily occupancy, not its licensed bed count or the census on the day in question, and the threshold in the rule is 60.

   Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.35(b)(3)

5. 5A business office manager asks the administrator how a Medicare Part A resident is classified for payment under the Patient Driven Payment Model. Which description matches the model's classification structure?

   1. A. The resident is classified into one and only one group for each of the five case-mix adjusted components
   2. B. The resident is classified into a single group that sets the case-mix index for every payment component
   3. C. The resident is classified into one group for therapy and one group for nursing, which are then combined
   4. D. The resident is classified into a new group each time an assessment is completed during the covered stay

   Answer: A

   Explanation: The CMS PDPM calculation worksheet states that "In the PDPM, there are five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Non-Therapy Ancillary (NTA), and Nursing. Each resident is to be classified into one and only one group for each of the five case-mix adjusted components." The same passage contrasts this with the predecessor system, "As opposed to RUG-IV, in which a resident's classification into a single group determines the case-mix indexes and per-diem rates for all case-mix adjusted components," which is exactly the single-group description offered as a distractor.

   Reference: PDPM Calculation Worksheet for SNFs — PDPM Calculation Worksheet for SNFs, introductory section describing the case-mix adjusted components

6. 6During a walk-through, an administrator notices that the doors to the soiled linen room and several resident corridor doors are fitted with roller latches. Under the federal physical environment requirement, what must be done?

   1. A. The doors must be provided with positive latching hardware, because roller latches are prohibited on such doors
   2. B. The doors must be provided with self-closing devices, because roller latches are permitted only on doors that close automatically
   3. C. The doors must be inspected each quarter, because roller latches are permitted where a documented inspection program exists
   4. D. The doors must be replaced with fire-rated assemblies, because roller latches are permitted only in fully sprinklered buildings

   Answer: A

   Explanation: 42 CFR 483.90(a)(1)(ii) provides that "corridor doors and doors to rooms containing flammable or combustible materials must be provided with positive latching hardware. Roller latches are prohibited on such doors." The prohibition is flat, so it is not relieved by adding self-closers, by an inspection program, or by the presence of a sprinkler system. Full sprinkler coverage matters elsewhere in the same paragraph, for example as an exception to the battery-operated smoke alarm requirement at 483.90(a)(5)(iii)(B).

   Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.90(a)(1)(ii); compare 483.90(a)(5)(iii)(B)

7. 7A resident was admitted to a skilled nursing facility 100 days ago and remains in the facility. Under the federal physician services requirement, how often must this resident now be seen by a physician?

   1. A. At least once every 60 days
   2. B. At least once every 30 days
   3. C. At least once every 90 days
   4. D. At least once every 45 days

   Answer: A

   Explanation: 42 CFR 483.30(c)(1) provides that "The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter." Because this resident is past day 90, the applicable interval has shifted from every 30 days to every 60 days. The rule contains no 45-day or 90-day visit interval.

   Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.30(c)(1)

8. 8A skilled nursing facility is projecting Medicare revenue for a resident expected to stay 40 days. Under the Patient Driven Payment Model, how does the variable per diem adjustment apply to the Non-Therapy Ancillary component?

   1. A. An adjustment factor of 3.0 applies to payment days 1 through 3 and a factor of 1.0 applies from day 4 onward
   2. B. An adjustment factor of 1.0 applies to payment days 1 through 20 and then declines in steps every seven days
   3. C. An adjustment factor of 3.0 applies to payment days 1 through 20 and a factor of 1.0 applies from day 21 onward
   4. D. An adjustment factor of 2.0 applies to payment days 1 through 3 and then declines in steps every seven days

   Answer: A

   Explanation: The CMS fact sheet on the variable per diem adjustment states that NTA costs "were found to be highly concentrated at the beginning of a stay and then decrease to a lower level that holds relatively constant over the remainder of the stay," and its NTA table pairs Medicare payment days 1-3 with an adjustment factor of 3.0 and days 4-100 with a factor of 1.0. The stepped schedule that begins at 1.00 for days 1-20 and then falls in seven-day increments is the separate PT and OT schedule in the same fact sheet, not the NTA schedule.

   Reference: Patient driven payment model — PDPM Fact Sheet: Variable Per Diem Adjustment, 'NTA Schedule' and the NTA adjustment factor table; compare the PT and OT table

9. 9A water main break forces a facility to shut down its automatic sprinkler system, and the contractor estimates the system will be out of service for about 14 hours. Under the federal physical environment requirement, what must the facility do?

   1. A. Evacuate the affected building or portion of the building until the system is back in service, or establish a fire watch until it is back in service
   2. B. Notify the State survey agency and the local fire authority, and restrict smoking throughout the affected portion of the building
   3. C. Increase the frequency of staff rounds on the affected units and test the fire alarm system at the beginning of every shift
   4. D. Relocate residents from sleeping rooms in the affected area into common areas that remain within sprinkler coverage

   Answer: A

   Explanation: 42 CFR 483.90(a)(8) provides that "When a sprinkler system is shut down for more than 10 hours, the LTC facility must:" "Evacuate the building or portion of the building affected by the system outage until the system is back in service, or" "Establish a fire watch until the system is back in service." A 14-hour outage crosses the 10-hour threshold, and the rule offers those two alternatives only. Increased rounds, smoking restrictions, alarm testing and internal relocation are reasonable precautions but none of them is the measure this paragraph requires.

   Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.90(a)(8)

10. 10A consultant pharmacist proposes a schedule for reviewing residents' medications. Under the federal pharmacy services requirement, how often must the drug regimen of each resident be reviewed by a licensed pharmacist?

    1. A. At least once a month
    2. B. At least once every three months
    3. C. At least once every six months
    4. D. At least once every two weeks

    Answer: A

    Explanation: 42 CFR 483.45(c)(1) requires that "The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist." The same paragraph requires that the review include a review of the resident's medical chart. Quarterly and semiannual intervals are longer than the rule permits, and the rule does not set a two-week cycle.

    Reference: Code of Federal Regulations, Title 42 — 42 CFR 483.45(c)(1)-(2)