AHA CHFM Certified Health Care Facility Manager (CHFM) Exam Practice Test

The Utilities Management standard under The Joint Commission’s Environment of Care requires healthcare organizations to manage utility systems—including water supply systems—to reduce the risk of healthcare-associated infections caused by waterborne pathogens such as Legionella. This includes monitoring, maintenance, and water management programs.

B: Safety Management deals with physical and occupational safety.

C: Medical Equipment Management relates to device safety and maintenance.

D: Hazardous Materials and Waste Management applies to chemical and biological waste handling, not waterborne pathogens.

In a fire tube boiler, hot gases of combustion pass through tubes, and water surrounds those tubes, absorbing the heat to create steam or hot water.

Correct: Fire tube (B) – Gases inside tubes, water outside.

Incorrect:

A. Water tube – The reverse: water flows inside the tubes, combustion gases surround them.

C. Vertical tube – Refers to orientation but still a water-tube or fire-tube design.

D. Cast iron sectional – Built from joined cast iron sections, not tubular gas-through-water design.

Hospitals must have a Type 1 Essential Electrical System (EES) as required by NFPA 99. Type 1 systems provide at least two separate branches: the Life Safety branch and the Critical branch, ensuring continuous power to essential life support, patient care, and safety functions during utility outages.

Type 2 systems (for smaller facilities) have fewer requirements.

Type A and B are not classifications under NFPA 99.

Overage = 140 cu. ft.

Each small cylinder = 25 cu. ft.

140 ÷ 25 = 5.6 → minimum 6 needed if rounding up. However, since the question asks for the minimum number to remove to get below the limit, removing 5 cylinders = 125 cu. ft. would still leave 15 cu. ft. over the limit. Therefore, 6 cylinders must be removed.

Correct answer = C (6), not B.

NFPA 10: Standard for Portable Fire Extinguishers requires that extinguishers be visually inspected at least monthly. This inspection confirms accessibility, proper charge, and readiness.

Weekly, quarterly, semi-annual are not correct; only monthly inspections are mandated.

MRI does not use ionizing radiation, so radiation-related injuries are not possible. The greatest risk is the “missile effect” where ferromagnetic objects (scissors, oxygen tanks, tools) are violently pulled into the MRI bore by its powerful magnetic field.

D. Missile projection (Correct): Most likely injury hazard.

A. Visual impairment: Not a typical MRI injury.

B. Radiation overexposure: MRI uses magnetic fields, not radiation.

C. Hearing loss: Possible from loud noise but mitigated with ear protection; less common than missile hazard.

Design–Bid–Build (DBB) is the traditional project delivery method where the architect/engineer completes design before contractors bid. The contractor has no input in the design phase.

IDP, DB, and CMAR all include contractor involvement earlier.

NFPA 72, National Fire Alarm and Signaling Code, is the controlling standard for inspection, testing, and maintenance (ITM) of fire alarm and signaling systems (see the ITM chapter—commonly Chapter 14). It details testing frequencies, procedures, and documentation requirements for initiating devices, notification appliances, control equipment, and interfaces.

The correct calculation shows an annual energy consumption of 158,444 kWh. Smaller values (A and B) underestimate by factor of 10, while D overestimates by factor of 100.

When fire protection systems (sprinklers, alarms) are impaired during construction, Interim Life Safety Measures (ILSM) must be implemented to maintain safety. These include fire watch, additional training, and temporary compensating measures.

B. ILSM (Correct): Required under TJC and NFPA 101 during impairments.

A. ICRA (Infection Control Risk Assessment): Applies to infection risk during construction, not fire protection.

C. PASS (Pull, Aim, Squeeze, Sweep): Fire extinguisher operation technique.

D. RACE (Rescue, Alarm, Contain, Extinguish): Emergency fire response procedure.

Builder’s risk insurance is first-party property insurance that covers physical loss to the work under construction, including the replacement or repair value of a structure and materials during the construction period. It does not provide workers’ compensation (A), payment bond protection for subcontractors (B), or performance/contractor default liability (D). Those are separate coverages (workers’ comp, payment bond, performance bond).

The correct sequence aligns with the Plan–Do–Check–Act (PDCA) cycle of continuous improvement:

Identify and prioritize opportunities (3).

Take action on those priorities (4).

Evaluate to confirm results (1).

Take further action if goals are not sustained (2).

This matches performance improvement processes emphasized in the CHFM Administration domain.

Scale forms where water is in direct contact with heated surfaces. In steam boilers, that location is below the water line, where dissolved minerals (calcium, magnesium, silica) precipitate and adhere to heat-transfer surfaces as scale. This reduces efficiency and can cause overheating of boiler tubes.

B. below the water line (Correct): Primary area where water meets heat-transfer surfaces; mineral deposits form here.

A. huddling chamber: This is part of a safety relief valve, not a surface for scale buildup.

C. weld above the water line: There is no continuous water exposure above the water line, so scale does not accumulate there.

D. blowdown valve: This is used to remove sludge/sediment, not a typical location for scale accumulation.

Comprehensive and Detailed Explanation From Exact Extract:

Per NFPA 101: Life Safety Code, the maximum allowable capacity for soiled linen or trash receptacles located outside of hazardous storage rooms (such as within patient rooms or nurse stations) is 32 gallons (121 liters). If containers are larger than this, they must be stored in a room meeting hazardous area protection requirements.

Correct Answer (C. 32 gal.): Matches NFPA 101, 18/19.7.5.5.7 (Health Care Occupancies), which restricts container size to 32 gallons maximum unless in a protected hazardous storage room.

Incorrect Options:

A. 8 gal. and B. 16 gal. – These are not the standard NFPA thresholds.

D. 64 gal. – Exceeds NFPA’s maximum; would require special hazardous storage protections.

Relevance to CHFM: This falls under the Compliance domain, as CHFM professionals must ensure healthcare facilities follow NFPA 101 and Joint Commission standards regarding fire and life safety.

22% excess oxygen is far higher than normal (typical excess O₂ is 3–6%). This means there is too much air compared to fuel, causing inefficiency.

The corrective action is to increase fuel pressure, which reduces excess oxygen by balancing the air-fuel ratio.

D. Increase the fuel pressure (Correct): Restores optimal combustion balance.

A. Steam atomization: Not relevant unless using certain oil burners.

B. Increase nozzle air pressure: Would worsen the excess O₂ condition.

C. No adjustment necessary: Incorrect because efficiency is compromised.

Per NFPA 13: Standard for the Installation of Sprinkler Systems, 18 inches of clearance must be maintained below sprinkler deflectors to ensure proper spray pattern and fire suppression coverage.

C. 18 (Correct).

Less than 18 inches (12 or 15) is insufficient clearance.

More than 18 (24 inches) exceeds the standard, not required.

Best practice in healthcare facilities management is to keep one critical spare part for each unique piece of patient-care equipment (not for every unit). This approach balances patient safety and risk mitigation while avoiding excessive storage costs.

A: “As needed” creates downtime risk.

B: Annual bulk purchase may leave gaps in urgent needs.

D: One-for-one spares is excessive, costly, and impractical.

Under the ADA Accessibility Guidelines (ADAAG), room identification signs must include raised tactile characters and Braille. These apply to permanent spaces such as patient rooms, restrooms, and offices.

C. room identification (Correct): Required by ADA to have tactile and Braille.

A. directional: May use visual characters only; Braille is not required.

B. informational: Same as directional, not required to have Braille.

D. mechanical spaces: These areas are typically staff-only; signs do not require tactile or Braille by ADA standards.

The Joint Commission (TJC) requires hospitals to conduct environmental tours (also called Environment of Care rounds) with the primary purpose of identifying hazards to patients, staff, and visitors. While compliance, risk categorization, and system failures may be evaluated, the main focus is proactive hazard identification to reduce safety risks.

CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities (1994, reaffirmed in later updates) require negative pressure isolation rooms as a primary engineering control. This ensures airflow moves into the room and is exhausted to the outside or through HEPA filtration. PPE and respirator fit testing are administrative or personal controls, not engineering.

Practical and ethical water conservation measures include landscape irrigation reduction (1) and metering cooling tower usage (3) since cooling towers are a major consumer of water.

2. Campaigns: Awareness is useful but not as effective as operational controls.

4. Reducing patient showers: Not appropriate for patient care and safety.

NFPA opening-protective tables specify that doors protecting openings in 2-hour fire-resistance-rated fire barriers are required to have a 1-1/2-hour (90-minute) fire protection rating. This distinction between the wall’s fire-resistance rating and the door’s fire-protection rating is standard in NFPA 101 and NFPA 80.

NFPA 101 (Life Safety Code) requires that on-call sleep rooms provided in healthcare facilities must be protected by single-station smoke alarms or an automatic smoke detection system. This requirement ensures early warning for occupants who may be sleeping and unable to respond as quickly in an emergency.

B: Rated doors may be required in certain hazardous areas but are not the mandated feature for on-call sleep rooms.

C: Emergency call buttons are part of patient care areas, not sleep rooms.

D: Bathrooms are not required by Life Safety Code in on-call rooms.

NFPA 80 (Standard for Fire Doors and Other Opening Protectives) sets requirements for fire door construction and installation. It specifies that the maximum undercut clearance is 3/4 inch unless otherwise tested and listed. Greater clearances compromise the integrity of the fire barrier.

According to NFPA 101 Life Safety Code and CMS/TJC corridor obstruction guidance, only certain items deemed essential for immediate patient care may be left unattended in inpatient care corridors. Crash carts are specifically allowed because they are emergency life-saving equipment. Other items, such as hampers, WOWs, and bins, are considered obstructions and must be removed when not in active use.

Best practice in safety and risk management is to have a final inspection performed by individuals with “fresh eyes” and go/no-go authority. Those directly involved may overlook issues due to task familiarity. Independent inspection reduces risk before re-energization.

A Hazard Vulnerability Analysis (HVA) evaluates probability/likelihood of events, impact/consequences on operations and safety, and surge/demand effects on services to prioritize preparedness and mitigation. While cost considerations inform later planning, the core HVA scoring focuses on likelihood, consequences, and demand effects.

Hospital-grade receptacles, as defined in UL 498 and required under NFPA 99 Health Care Facilities Code, must be marked with a green dot. This identifies receptacles tested for durability, grounding reliability, and retention force.

Red outlets are often tied to emergency power, but that is separate from the “hospital grade” designation.

NFPA 99, Health Care Facilities Code, sets the requirements for medical gas and vacuum systems, including design, installation, testing, and maintenance (in recent editions, see the chapter dedicated to Gas and Vacuum Systems). It also addresses source equipment, piping, alarms, and verification procedures used in patient care spaces.

The simple payback period is calculated by dividing the initial investment cost by the annual operating savings (reduction in operating cost). It does not consider time value of money, inflation, or full life-cycle costs.

A (Correct): Annual operating cost directly determines the annual savings, which is essential for payback calculation.

B: Inflation is considered in more advanced financial models (e.g., NPV, IRR), not simple payback.

C: Replacement cost is relevant for life-cycle cost analysis, not simple payback.

D: Life of the equipment may determine feasibility but is not part of the basic payback formula.

NFPA 101 (Life Safety Code, Section 9.6.1.6) requires that when a fire alarm system is out of service for more than 4 hours in a 24-hour period, the facility must (1) notify the authority having jurisdiction (AHJ) and (2) provide an approved fire watch until the system is restored. Internal notifications such as to administrators or vendors may occur, but the code specifically mandates AHJ notification and fire watch.

Comprehensive and Detailed Explanation From Exact Extract:

MRI (Magnetic Resonance Imaging) scanners do not use ionizing radiation; instead, they use powerful magnetic fields and radiofrequency energy. The primary safety hazard is the projectile effect (missile effect), where ferromagnetic objects are pulled violently into the scanner bore. This is one of the most well-documented risks in MRI safety and is a leading cause of MRI accidents.

Correct Answer (D. missile projection): Strong magnetic fields can accelerate ferromagnetic objects, causing serious patient/staff injury or equipment damage.

Incorrect Options:

A. visual impairment: Not a recognized risk from MRI scanning itself.

B. radiation overexposure: MRI does not use ionizing radiation, unlike CT or X-ray.

C. permanent hearing loss: While MRI noise can be damaging without ear protection, the most likely injury of those listed is projectile accidents.

Relevance to CHFM: This falls under Compliance and Safety domains. Facility managers must ensure MRI safety zones, access control, ferromagnetic detection systems, and staff training to prevent accidents.