Free NAB National Core Knowledge Exam for Long-Term Care Administrators (CORE) Practice Questions

Sample Practice Questions

Try these 10 sample questions from the NAB National Core Knowledge Exam for Long-Term Care Administrators (CORE) practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A resident was admitted to a nursing facility without an indwelling urinary catheter. Three weeks later the charge nurse proposes inserting one because frequent incontinence care is consuming staff time on the evening shift. Under the federal quality of care requirement governing urinary incontinence, on what basis may this resident be catheterized?

   1. A. Only if the resident's clinical condition demonstrates that catheterization was necessary
   2. B. Only if the interdisciplinary team has determined that the practice is clinically appropriate
   3. C. Only if the least restrictive alternative is used for the least amount of time and re-evaluated
   4. D. Only if the resident's needs cannot be met in the facility and a physician documents that fact

   Answer: A

   Explanation: The controlling text is the incontinence standard: the facility must ensure that "A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary". Staff workload is not a clinical indication, so the proposal fails the standard. The other options quote decision rules that the same regulation attaches to different subjects: the interdisciplinary team's determination governs whether a resident may self-administer medications, the least restrictive alternative rule governs restraint use, and the unmet-need finding is a basis for transfer or discharge, not for catheterization.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.25(e)(2)(i)

2. 2At 9:00 a.m. a nurse aide reports that another aide struck a resident, leaving a bruise but no serious bodily injury. Under the federal requirement governing response to allegations of abuse, by when must the facility report the allegation to the administrator and the State Survey Agency?

   1. A. Not later than 2 hours after the allegation is made
   2. B. Not later than 24 hours after the allegation is made
   3. C. Not later than the end of the business day on which the allegation is made
   4. D. Not later than 5 working days after the allegation is made

   Answer: A

   Explanation: The regulation requires that alleged violations be "reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury". Because the allegation involves abuse, the two-hour clock applies even though the injury was not serious. The 24-hour figure covers the other branch of the same sentence, and 5 working days is the deadline for reporting investigation results.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.12(c)(1), compared with 483.12(c)(4)

3. 3A surveyor asks the administrator to describe the two elements the facility's antibiotic stewardship program must contain under the federal infection control requirement. What are they?

   1. A. Antibiotic use protocols and a system to monitor antibiotic use
   2. B. Antibiotic use protocols and a system of surveillance for communicable diseases
   3. C. A written exposure control plan and a system to monitor antibiotic use
   4. D. A written exposure control plan and a record of incidents and corrective actions

   Answer: A

   Explanation: The infection control regulation requires "An antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use." Disease surveillance and the record of incidents and corrective actions are separately listed elements of the overall infection prevention and control program rather than components of the stewardship program, and the written exposure control plan is the document the occupational bloodborne pathogens standard requires of the employer.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.80(a)(3), compared with 483.80(a)(2)(i) and 483.80(a)(4)

4. 4A facility's governing body delegates all quality work to the director of nursing and takes no further part. Under the federal QAPI requirement for governance and leadership, for what is the governing body responsible and accountable?

   1. A. Ensuring the QAPI program is defined, implemented, maintained, adequately resourced and sustained during transitions in leadership and staffing
   2. B. Ensuring the QAPI program is defined and implemented and that the director of nursing reports program results to it at least quarterly
   3. C. Ensuring the QAPI program is reviewed by the quality assessment and assurance committee and approved before each recertification survey
   4. D. Ensuring the QAPI program is consistent with the facility assessment and revised whenever the resident population changes substantially

   Answer: A

   Explanation: The regulation makes the governing body or executive leadership "responsible and accountable for ensuring that" an ongoing QAPI program "is defined, implemented, and maintained and addresses identified priorities," that it "is sustained during transitions in leadership and staffing," and that it "is adequately resourced, including ensuring staff time, equipment, and technical training as needed." Quarterly reporting by the quality assessment and assurance committee, review before a survey and alignment with the facility assessment are all real features of the same scheme, but none of them describes the accountability this paragraph assigns.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.75(f)(1)-(3), compared with 483.75(g)(2)(i) and 483.71

5. 5A nursing facility decides to install side rails on the bed of a resident who has begun sliding toward the edge of the mattress at night. Staff have already assessed the resident for risk of entrapment. Under the federal bed rail requirement, what else must the facility obtain before the rails are installed?

   1. A. Informed consent from the resident or resident representative after reviewing the risks and benefits
   2. B. A written order from the attending physician specifying the intended duration of the device
   3. C. Documentation from the medical director that the device is required to treat a medical symptom
   4. D. Approval from the quality assessment and assurance committee at its next scheduled meeting

   Answer: A

   Explanation: The bed rail standard lists the required steps, including that the facility must "Review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation." Entrapment assessment is a separate listed element and does not substitute for consent. A written physician order is the stated condition for specialized rehabilitative services, not for bed rails; the medical-symptom finding belongs to the restraint rule; and the quality assessment and assurance committee's role is to review quality data and develop plans of action, not to clear individual devices.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.25(n)(1)-(2)

6. 6A facility completes its internal investigation of an alleged misappropriation of a resident's property. Under the federal requirement, when must the results be reported to the administrator and to the State Survey Agency?

   1. A. Within 5 working days of the incident
   2. B. Within 2 hours of completing the investigation
   3. C. Within 24 hours of completing the investigation
   4. D. Within 10 working days of the incident

   Answer: A

   Explanation: The regulation requires the facility to "Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken." The two-hour and 24-hour figures are the deadlines for the initial report of the allegation, not for investigation results, and 10 working days is not a period this section uses.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.12(c)(4), compared with 483.12(c)(1)

7. 7A resident wants to bring her own recliner and a small dresser into a shared room that has space for them, and neither item creates a hazard. Under the federal respect and dignity right, what does the regulation provide?

   1. A. The resident has a right to retain and use personal possessions, including furnishings and clothing, as space permits
   2. B. The resident has a right to individual closet space in the bedroom with clothes racks and shelves accessible to her
   3. C. The resident has a right to a separate bed of proper size and height for her safety and convenience
   4. D. The resident has a right to reasonable accommodation of her needs and preferences in the delivery of services

   Answer: A

   Explanation: The regulation gives the resident "The right to retain and use personal possessions, including furnishings, and clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents." Individual closet space and a separate bed of proper size and height are real entitlements, but they are items the facility must furnish rather than a right to bring one's own; and the general accommodation right does not supply the specific permission for personal furnishings that this paragraph states.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.10(e)(2), compared with 483.90(e)(2)(i) and (iv) and 483.10(e)(3)

8. 8An owner appoints himself administrator and tells the board of directors that he will report to no one. Under the federal administration requirement governing the governing body, how must the administrator position be structured?

   1. A. The governing body appoints the administrator, who is licensed where required, is responsible for management of the facility, and reports to and is accountable to the governing body
   2. B. The governing body appoints the administrator, who is licensed where required, is responsible for management of the facility, and reports to and is accountable to the medical director
   3. C. The governing body ratifies the owner's selection of the administrator, who is responsible for management of the facility and accountable to the operating organization
   4. D. The governing body appoints the administrator, who is licensed where required, is responsible for resident care policies, and is accountable to the quality assessment committee

   Answer: A

   Explanation: The regulation provides that the facility must have a governing body "that is legally responsible for establishing and implementing policies regarding the management and operation of the facility" and that "The governing body appoints the administrator who is" "Licensed by the State, where licensing is required;" "Responsible for management of the facility; and" "Reports to and is accountable to the governing body." Implementation of resident care policies is the medical director's responsibility, and the quality assessment and assurance committee itself reports to the governing body rather than receiving the administrator's accountability.

   Source: Code of Federal Regulations, Title 42 — 42 CFR 483.70(d)(1)-(2), compared with 483.70(g)(2)(i) and 483.75(g)(2)

9. 9A resident is admitted to a nursing facility on March 1. The administrator is auditing whether attending physicians are meeting the federally required visit schedule. During the first 90 days after admission, how often must each resident be seen by a physician?

   1. A. At least once every 30 days
   2. B. At least once every 14 days
   3. C. At least once every 60 days
   4. D. At least once every 90 days

   Answer: A

   Explanation: The frequency standard states: "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." The 60-day interval is the real value, but it applies only after the first 90 days; 14 days and 90 days are not visit intervals set by this section.

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

10. 10A dietary aide forms a reasonable suspicion that a crime has been committed against a resident, and the events that caused the suspicion resulted in serious bodily injury. Under the federal crime reporting requirement applicable to covered individuals, to whom and by when must the report be made?

    1. A. To the State Agency and one or more local law enforcement entities, not later than 2 hours after forming the suspicion
    2. B. To the facility administrator and the State Agency, not later than 2 hours after forming the suspicion
    3. C. To the State Agency and one or more local law enforcement entities, not later than 24 hours after forming the suspicion
    4. D. To the facility administrator and the medical director, immediately upon forming the suspicion

    Answer: A

    Explanation: The regulation requires that "Each covered individual shall report to the State Agency and one or more law enforcement entities for the political subdivision in which the facility is located any reasonable suspicion of a crime against any individual who is a resident of, or is receiving care from, the facility," and "shall report immediately, but not later than 2 hours after forming the suspicion, if the events that cause the suspicion result in serious bodily injury, or not later than 24 hours if the events that cause the suspicion do not result in serious bodily injury." The 24-hour branch does not apply here, and reporting only inside the facility does not satisfy this obligation.

    Source: Code of Federal Regulations, Title 42 — 42 CFR 483.12(b)(5)(i)(A)-(B)