Licensure as a nursing home administrator runs through two NAB exams: the Core of Knowledge Exam, required for all long-term care administrator candidates, and the NHA Line of Service Exam, which is nursing home-specific. Both cover the same 4 domains. You must pass both to become a licensed Nursing Home Administrator.
The authoritative structure is NAB's Domains of Practice (effective March 1, 2022), one outline applied across all lines of service, and it governs exams through June 30, 2027. The full document is published on nabweb.org; the summaries below follow it. Testing on or after July 1, 2027? The structure is changing: see the 2027 changes below.
The resident-facing domain: direct care, clinical standards, and the services a facility delivers to the people living in it. In practice questions this is where clinical material lives, from pressure ulcer staging and fall prevention to nutrition, care planning, and resident rights in day-to-day care. NAB's outline splits it into three areas:
This domain carries heavy weight on both exams, and it is where clinical vocabulary matters most for candidates coming from a business background rather than a nursing one.
The widest domain, and the one administrators live in daily. NAB's outline splits it into three areas:
In NHA Exam Prep's question bank, Operations practice is organized into Regulations, Human Resources, and Finance focus areas so you can drill each thread separately. Many AITs focus on Operations early in their program because it maps directly onto the day job.
The building, the systems that keep it safe, and the regulatory machinery that inspects both. NAB's outline splits it into two areas:
Note where the survey process officially lives: candidates often expect it under Operations, but NAB places regulatory compliance here, which is part of why this domain deserves more respect than its size suggests.
Governance, ethics, strategic planning, and the leadership decisions that sit above daily operations. NAB's outline splits it into two areas:
It is the smallest slice of the Core exam, and on the NHA Line of Service its content is largely folded into scenarios from the other domains.
One more category worth calling out: math. Calculation questions, including occupancy rate, FLSA overtime, staffing hours, depreciation, and financial ratios, appear across domains rather than as a separate section. We cover every formula in The 15 NAB Math Calculations, Explained.
Both exams draw from the same 4 domains, but they do not weight them the same way. The Core tests foundational knowledge applicable across all lines of long-term care. The NHA Line of Service tests the same domains with nursing-home-specific weighting and scenarios.
| Domain | Approximate share of content |
|---|---|
| Care, Services & Supports | Most tested |
| Operations | Most tested |
| Environment & Quality | Some |
| Leadership & Strategy | Less |
Approximate share of exam content by domain. Care & Services and Operations carry the most weight.
| Domain | Approximate share of content |
|---|---|
| Care, Services & Supports | Most tested |
| Operations | More |
| Environment & Quality | More |
| Leadership & Strategy | Folded in |
Approximate share of exam content by domain. Leans harder on Care & Services and Environment & Quality.
The Domains of Practice outline above defines what is testable but does not assign percentages; exact domain weightings are published by NAB. Always verify against the current NAB Candidate Handbook before your exam, and check with your state licensing board: some states require additional state-specific exams or licensing steps beyond the two NAB exams.
NAB has announced a restructure: starting with exams delivered on or after July 1, 2027, the four domains become nine stand-alone Domains of Practice. The nine are the same areas described above, promoted to full domains, so nothing new becomes testable. NAB states plainly that the 2026 Domains do not change what administrators are expected to know; the framework is being reorganized for clarity, and a third level of task statements is being added to the blueprint.
The 2026 blueprints also publish something the current outline never did: an official scored-question count per domain. These counts cover the scored questions only; the unscored pretest items (25 on the Core, 15 on the NHA) sit on top of them.
| Domain | Scored questions |
|---|---|
| 1. Quality of Care | 15 |
| 2. Quality of Life | 12 |
| 3. Financial Management | 10 |
| 4. Risk Management | 9 |
| 5. Human Resources | 9 |
| 6. Care Setting | 9 |
| 7. Regulatory Compliance | 13 |
| 8. Leadership | 13 |
| 9. Organizational Strategy | 10 |
| Domain | Scored questions |
|---|---|
| 1. Quality of Care | 12 |
| 2. Quality of Life | 10 |
| 3. Financial Management | 8 |
| 4. Risk Management | 7 |
| 5. Human Resources | 7 |
| 6. Care Setting | 7 |
| 7. Regulatory Compliance | 9 |
The 2026 NHA blueprint has no stand-alone Leadership or Organizational Strategy domains: those areas appear only on the Core, which matches how the current exam folds leadership content into other domains' scenarios.
Sources: the 2026 Core blueprint and 2026 NHA blueprint on nabweb.org. If your exam date lands near the July 1, 2027 boundary, confirm with NAB and your state board which blueprint applies to you.
The practical problem with a 4-domain exam is coverage decay: while you drill one domain, the others go stale. A structured rotation solves it. NHA Exam Prep's daily path runs two rotating domain drills on a 4-day cycle through every Core domain plus the NHA Line of Service, aims a Weak Spot round at your lowest-scoring domain automatically, and closes each day with a mixed exam spanning every domain plus math, so nothing sits untouched for long.
Most candidates have a weak spot. The domain breakdown finds yours, and the daily path drills it until it is not one anymore.
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