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Free NHA Practice Questions

10 free, exam-style Nursing Home Administrator (NHA) practice questions with answers and explanations. No signup required. Work through them below, then take the full free NHA practice test to study every exam domain.

Question 1

A long-term resident experiences a significant, non-temporary decline affecting multiple areas of function. After the interdisciplinary team confirms the change, by when must the Significant Change in Status Assessment (SCSA) be completed?

  1. By the end of the 14th calendar day after the team determines the change occurred
  2. Within 48 hours, because any functional decline is treated as an emergency assessment
  3. Only at the resident's next regularly scheduled quarterly assessment
  4. Within 30 days, consistent with the comprehensive annual reassessment timeframe
Show answer & explanation

Correct answer: A - By the end of the 14th calendar day after the team determines the change occurred

Question 2

A resident who has full decision-making capacity refuses a treatment ordered by the physician. What is the administrator's MOST appropriate course of action?

  1. Administer the treatment anyway, since a physician's order legally overrides resident preference
  2. Begin discharge planning, because refusing ordered care is noncompliance with the plan of care
  3. Respect and document the refusal, and continue offering appropriate care
  4. Ask the resident's family to authorize the treatment on the resident's behalf
Show answer & explanation

Correct answer: C - Respect and document the refusal, and continue offering appropriate care

Question 3

A nurse aide repeatedly fails to reposition an immobile resident as required by the care plan, and the resident develops a facility-acquired pressure injury. Under federal regulation, this is MOST accurately classified as:

  1. Abuse, because the resident sustained physical harm from the lapse in care
  2. Neglect, because needed care was not provided and harm resulted
  3. Exploitation, because staff misused a position of trust over the resident
  4. Involuntary seclusion, because the resident was effectively confined to bed
Show answer & explanation

Correct answer: B - Neglect, because needed care was not provided and harm resulted

Question 4

A nursing facility wishes to initiate the discharge of a resident. Which of the following is a PERMISSIBLE reason for a facility-initiated discharge under federal regulation?

  1. The resident has repeatedly filed grievances about the quality of their care
  2. The resident has failed to pay after reasonable and appropriate notice
  3. The resident's care has become more time-consuming than staff prefer to provide
  4. The resident's family frequently disagrees with the care team's recommendations
Show answer & explanation

Correct answer: B - The resident has failed to pay after reasonable and appropriate notice

Question 5

Under the Patient-Driven Payment Model (PDPM), a skilled nursing facility's Medicare Part A per-diem reimbursement is primarily driven by:

  1. The total number of therapy minutes delivered to the resident each week
  2. The facility's current overall Five-Star Quality Rating
  3. The resident's clinical characteristics and care needs
  4. A flat daily rate multiplied by the resident's total length of stay
Show answer & explanation

Correct answer: C - The resident's clinical characteristics and care needs

Question 6

A full-time employee who has worked at the facility for 14 months requests 10 weeks of leave to care for a spouse with a serious health condition. Assuming the facility and employee meet the size and hours thresholds, the administrator should:

  1. Approve up to 12 weeks of unpaid, job-protected leave
  2. Deny the request, because FMLA leave does not cover caring for a spouse
  3. Approve the leave only if the employee agrees to give up their position upon return
  4. Limit the leave to the amount of paid time off the employee has accrued
Show answer & explanation

Correct answer: A - Approve up to 12 weeks of unpaid, job-protected leave

Question 7

During a standard survey, a facility receives a deficiency cited at scope-and-severity level 'J.' This citation indicates:

  1. An isolated deficiency that resulted in no actual harm and only minimal potential for harm
  2. A widespread deficiency carrying only the potential for minimal resident harm
  3. An isolated instance of immediate jeopardy to resident health or safety
  4. A pattern of deficiencies that requires only an accepted plan of correction
Show answer & explanation

Correct answer: C - An isolated instance of immediate jeopardy to resident health or safety

Question 8

All of the following are recognized elements of a facility's QAPI program EXCEPT:

  1. Feedback, data systems, and performance monitoring
  2. Systematic analysis and systemic action
  3. Performance improvement projects (PIPs)
  4. Imposition of civil money penalties
Show answer & explanation

Correct answer: D - Imposition of civil money penalties

Question 9

A prospective resident's Level I PASRR screen is positive for indicators of serious mental illness. Before this individual can be admitted to the nursing facility, what must occur?

  1. The individual may be admitted right away, as long as the completed Level I screen is kept in the record
  2. The individual must be referred to a psychiatric hospital rather than to the nursing facility
  3. A physician's order may be obtained to waive the need for any further screening
  4. A Level II evaluation must be completed before the individual is admitted
Show answer & explanation

Correct answer: D - A Level II evaluation must be completed before the individual is admitted

Question 10

A nursing home's governing board has a fiduciary duty to the organization. This duty MOST directly requires board members to:

  1. Act in the best interests of the organization
  2. Direct and oversee the facility's day-to-day clinical and staffing operations
  3. Personally guarantee repayment of the organization's outstanding debts
  4. Review and approve each resident's individual plan of care
Show answer & explanation

Correct answer: A - Act in the best interests of the organization

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