Certified Medication Aide (CMA) — All Questions

Insulin is classified as a hormone and is used to:

• a.Lower blood glucose in diabetes✓
• b.Relieve pain and reduce inflammation
• c.Raise blood glucose during fasting
• d.Treat high blood pressure in older adults

Insulin lowers blood glucose by moving sugar into cells and is essential in type 1 and some type 2 diabetes. Too much insulin or a missed meal can cause dangerous hypoglycemia, which the aide must recognize.

A bronchodilator such as albuterol is used to:

• a.Open the airways to ease breathing✓
• b.Slow the heart rate at rest
• c.Prevent blood clots in the legs
• d.Reduce stomach acid

Bronchodilators relax and widen the airways to relieve wheezing and shortness of breath in conditions like asthma and COPD. Rapid heartbeat and tremor can occur as side effects.

Which statement about controlled substances is correct?

• a.They must be kept locked and reconciled with a documented count✓
• b.They may be stored loosely in an unlocked drawer on the cart
• c.They need to be counted only when a resident is discharged
• d.Any staff member may take them home overnight to keep them safe for residents

Federal nursing-home rules require controlled drugs to be stored under lock (Schedule II drugs in separately locked, permanently affixed compartments) and tracked with records detailed enough for an accurate reconciliation (42 CFR 483.45(b)(2) and (h)(2)). How often the count is done, often at shift change, is set by facility policy and state rules. Discrepancies must be reported immediately.42 CFR 483.45(b)(2), (h)(2)

A resident taking a loop diuretic such as furosemide shows muscle weakness and an irregular pulse. This may indicate:

• a.A need to give a double dose of the diuretic at the next scheduled time
• b.That the diuretic is working perfectly and removing extra fluid
• c.A normal, expected response to the drug that needs no action
• d.A potassium imbalance that should be reported to the nurse✓

Loop diuretics can lower potassium, and symptoms like muscle weakness, cramps, and irregular heartbeat can signal an electrolyte imbalance. The aide reports these findings promptly so the nurse can evaluate.

Which drug form is designed to be inserted and melt at body temperature?

• a.Sublingual tablet
• b.Capsule
• c.Transdermal patch
• d.Suppository✓

A suppository is a solid form inserted rectally or vaginally that melts at body temperature to release medication. It is stored cool and inserted per proper technique.

A resident is allergic to penicillin. If a penicillin-class antibiotic appears on the MAR, the aide should:

• a.Give it because the order is written
• b.Hold the dose and notify the nurse immediately about the allergy✓
• c.Give it with extra water and a snack to reduce any reaction
• d.Give half the dose first to test tolerance

A documented allergy is a contraindication, so the aide must not administer a drug the resident is allergic to and should alert the nurse right away. Allergic reactions can be life threatening, so this safety check is essential.

Nitroglycerin given sublingually for chest pain works by:

• a.Relaxing and widening blood vessels to improve blood flow to the heart✓
• b.Raising blood pressure quickly to push more blood to the heart
• c.Thickening the blood so the heart pumps harder
• d.Speeding up the heart rate sharply so that the heart muscle receives more oxygen

Nitroglycerin is a vasodilator that relaxes blood vessels, improving oxygen supply to the heart and relieving angina. It can lower blood pressure and cause headache, so the resident should be seated and monitored.

A stool softener such as docusate is classified as a laxative. Its therapeutic purpose is to:

• a.Relieve chest pain by relaxing and widening the blood vessels around the heart
• b.Lower blood sugar by helping the body use insulin
• c.Soften stool and ease bowel movements to relieve or prevent constipation✓
• d.Reduce blood pressure by removing extra fluid and salt through the kidneys

Laxatives and stool softeners promote bowel elimination, which is common in older adults and those on opioids that cause constipation. The aide monitors bowel patterns and reports problems to the nurse.

The order is 500 mg. The tablets on hand are 250 mg each. How many tablets should the aide give? (tablets = ordered ÷ available)

• a.3 tablets
• b.2 tablets✓
• c.1/2 tablet
• d.1 tablet

Using tablets = ordered dose ÷ available strength = 500 mg ÷ 250 mg = 2 tablets. Always confirm the calculated amount is a reasonable, safe number of tablets.

The order is 0.5 g of a medication. The tablets available are 500 mg each. How many tablets are needed? (First convert 0.5 g to mg.)

• a.1/2 tablet
• b.1 tablet✓
• c.5 tablets
• d.2 tablets

Convert grams to milligrams: 0.5 g × 1000 = 500 mg, then tablets = 500 mg ÷ 500 mg = 1 tablet. Converting to the same unit before dividing prevents serious dosing errors.

The order is 750 mg. Tablets are 250 mg each. How many tablets should be given?

• a.4 tablets
• b.2 tablets
• c.3 tablets✓
• d.1 tablet

tablets = 750 mg ÷ 250 mg = 3 tablets. The result is a whole number of scored or unscored tablets, which the aide double-checks against the order.

A liquid medication is ordered as 250 mg. The bottle is labeled 125 mg per 5 mL. How many mL should the aide give? (mL = ordered ÷ available strength × volume)

• a.10 mL✓
• b.5 mL
• c.15 mL
• d.2.5 mL

Set up the ratio: 250 mg ÷ 125 mg = 2, then 2 × 5 mL = 10 mL. Liquid calculations use the concentration (mg per mL) provided on the label.

An order calls for 1 teaspoon of a liquid. How many mL is this equal to?

• a.1 mL
• b.5 mL✓
• c.3 mL
• d.2 mL

One teaspoon (tsp) equals 5 mL, a standard household-to-metric conversion. Using an accurate measuring device rather than a kitchen spoon ensures the correct volume.

A resident is ordered 15 mL of a liquid. How many teaspoons is that?

• a.5 teaspoons
• b.3 teaspoons✓
• c.15 teaspoons
• d.1 teaspoon

Since 1 tsp = 5 mL, then 15 mL ÷ 5 mL = 3 teaspoons (also equal to 1 tablespoon). Converting correctly avoids under- or overdosing when household measures are used.

The order is 1000 mg. How many grams is that?

• a.100 g
• b.0.1 g
• c.1 g✓
• d.10 g

Because 1 g = 1000 mg, then 1000 mg = 1 g. Moving between grams and milligrams requires multiplying or dividing by 1000.

The order is 125 mg and tablets are 250 mg (scored). How many tablets should be given?

• a.1/2 tablet✓
• b.1/4 tablet
• c.2 tablets
• d.1 tablet

tablets = 125 mg ÷ 250 mg = 0.5, or one-half tablet, which is possible only if the tablet is scored. If a tablet is not scored or should not be split, the aide checks with the nurse or pharmacy.

A medication label reads 100 mg per tablet, and the order is for 300 mg twice a day. How many tablets are given PER DOSE?

• a.6 tablets
• b.2 tablets
• c.3 tablets✓
• d.1 tablet

Per dose: 300 mg ÷ 100 mg = 3 tablets, given twice daily (6 tablets total per day). The aide calculates the amount for a single dose, not the daily total, at each administration.

Convert 2 g to milligrams.

• a.200 mg
• b.20 mg
• c.0.002 mg
• d.2000 mg✓

Multiply grams by 1000: 2 g × 1000 = 2000 mg. Keeping units consistent is critical before performing any dosage division.

The order is 20 mg of a liquid concentrated at 10 mg/mL. How many mL should the aide draw up?

• a.20 mL
• b.2 mL✓
• c.0.5 mL
• d.1 mL

Using the concentration: 20 mg ÷ 10 mg/mL = 2 mL. Dimensional analysis cancels the mg units and leaves the correct volume in mL.

An order reads 'give 5 mL.' Using a household conversion, this equals approximately:

• a.1 teaspoon✓
• b.1 tablespoon
• c.2 teaspoons
• d.1/2 teaspoon

5 mL equals 1 teaspoon. A calibrated oral syringe or medicine cup should be used because kitchen spoons vary in size.

The order is 0.25 mg and the tablets available are 0.125 mg each. How many tablets should be given?

• a.4 tablets
• b.1/2 tablet
• c.1 tablet
• d.2 tablets✓

tablets = 0.25 mg ÷ 0.125 mg = 2 tablets. Careful handling of decimals prevents ten-fold dosing errors, which are a common cause of harm.

A resident needs 30 mL of a liquid. How many tablespoons is this (1 tbsp = 15 mL)?

• a.1 tablespoon
• b.6 tablespoons
• c.2 tablespoons✓
• d.3 tablespoons

Since 1 tablespoon = 15 mL, then 30 mL ÷ 15 mL = 2 tablespoons. Confirming the household equivalent helps when a metric device is unavailable, though a calibrated device is preferred.

Ratio and proportion: if 250 mg is contained in 5 mL, how many mL contain 100 mg? (Set 250/5 = 100/x)

• a.4 mL
• b.5 mL
• c.2 mL✓
• d.1 mL

Cross-multiplying: 250x = 5 × 100 = 500, so x = 2 mL. Ratio and proportion is a reliable method for liquid dosage problems when units match.

An order is written for 1.5 g. The available tablets are 500 mg each. How many tablets are needed?

• a.5 tablets
• b.1 tablet
• c.2 tablets
• d.3 tablets✓

Convert 1.5 g to 1500 mg, then tablets = 1500 mg ÷ 500 mg = 3 tablets. Converting to a common unit before dividing gives the correct whole-tablet answer.

A resident's digoxin order says 'hold if apical pulse is below 60.' The aide should withhold the dose and notify the nurse if:

• a.The resident just ate breakfast
• b.The blood pressure is above 120/80
• c.The apical pulse is 72 beats per minute
• d.The apical pulse is below 60 beats per minute✓

The hold parameter comes from the order. Here the order says to hold for an apical pulse under 60, so a pulse below 60 means the dose is held and the nurse is told. A pulse of 72 meets the order, and a meal or a normal blood pressure is not part of this parameter. Following hold parameters prevents dangerous bradycardia and toxicity.

An antihypertensive order says 'hold for systolic BP less than 100.' The resident's BP is 92/58. The aide should:

• a.Hold the dose and notify the nurse✓
• b.Give the medication anyway
• c.Give a double dose to raise the pressure
• d.Recheck in four hours and give then

A systolic pressure of 92 is below the hold parameter of 100, so the medication is withheld to avoid dangerously low blood pressure and the nurse is notified. Hold parameters protect residents from harmful drops in vital signs.

The 'three checks' of medication safety refer to checking the label:

• a.With three different nurses, one at the start, middle, and end of each shift
• b.On three different days before the medication is first given to the resident
• c.When removing it from storage, while preparing it, and before giving it to the resident✓
• d.At three points: when it is ordered, when the pharmacy delivers it, and when it expires

The three checks occur at retrieval, preparation, and administration to confirm the right drug, dose, and resident each time. This routine catches errors before the medication reaches the resident.

'High-alert medications' such as insulin and anticoagulants are called high-alert because:

• a.They are the most expensive drugs in the facility and must be tracked for billing
• b.They carry a higher risk of causing serious harm if an error occurs✓
• c.They must always be given first, before any other medication on the pass
• d.They never cause side effects

High-alert medications have a heightened risk of significant patient harm when used in error, so they often require extra checks or independent double-checks. Insulin, anticoagulants, and opioids are common examples.

How should a resident's medication allergy be handled by the aide?

• a.Ignore allergies for oral medications, since reactions only happen with injections
• b.Memorize the allergy but leave it off the record to protect the resident's privacy
• c.Give the drug once while watching closely, to confirm that the reported allergy is real before charting
• d.Verify the allergy before giving any drug and never give a medication the resident is allergic to✓

Allergies must be checked before every administration, and no drug to which the resident is allergic should be given because reactions can be severe. Any suspected allergic reaction is reported to the nurse immediately.

Which action is OUTSIDE the typical scope of practice for a certified medication aide?

• a.Adjusting a resident's medication dose without an order✓
• b.Documenting a medication on the MAR right after giving it
• c.Giving an oral tablet exactly as ordered by the prescriber
• d.Applying a topical cream to the site listed in the order

Medication aides administer medications as ordered but cannot change doses, prescribe, or make independent clinical judgments, which are nursing or provider responsibilities. Working within scope protects residents and the aide's certification.

Delegation of medication administration to an aide is appropriate only when:

• a.The resident is asleep and will not notice who gives the medication
• b.The aide feels confident about the task, regardless of training or state certification
• c.Any staff member on duty, even someone in housekeeping, says that it is fine to go ahead
• d.The task is within the aide's training and scope and is properly authorized/supervised✓

Delegation must match the aide's training and legal scope with appropriate nursing supervision and authorization. If a task exceeds the aide's scope, the aide should decline and refer it to the nurse.

Expired or discontinued medications should be:

• a.Disposed of per facility policy and never given to a resident✓
• b.Left in the resident's drawer indefinitely in case the order is restarted
• c.Taken home by staff for personal use
• d.Given quickly before they expire completely

Expired and discontinued drugs must be removed and disposed of according to facility and regulatory policy, not administered. Proper disposal prevents accidental use and diversion.

Controlled substances in a facility must be:

• a.Counted only once a month, during the pharmacist's visit
• b.Kept in a locked, secured area with an accurate count and documentation✓
• c.Shared between residents when one resident runs out
• d.Stored in the resident's room in a pocket or purse

Because of abuse and diversion risk, federal rules require controlled drugs to be kept under lock (Schedule II in separately locked, permanently affixed compartments) with records that allow an accurate reconciliation (42 CFR 483.45(b)(2), (h)(2)). Count frequency and witnessing follow facility policy and state rules; any discrepancy must be reported right away. Drugs are never shared between residents.42 CFR 483.45(b)(2), (h)(2)

A resident has the right to refuse medication. This is an example of:

• a.A safety hazard that staff should override when needed
• b.Protecting the resident's rights and autonomy✓
• c.An outdated policy that facilities no longer follow
• d.A rule that applies only when a nurse gives the medication

Residents retain the right to make decisions about their own care, including refusing medication, which the aide must respect, document, and report. Honoring resident rights is both an ethical and a legal requirement.

Before giving a medication with a hold parameter for pulse, the aide should:

• a.Give the drug first, then check the pulse within the next hour
• b.Ask the resident to estimate their own pulse and chart that number on the MAR
• c.Skip the pulse if the resident looks fine and says they feel well
• d.Measure the pulse and compare it to the ordered parameter before administering✓

Vital-sign hold parameters require measuring the value (such as pulse or blood pressure) before administration and holding the dose if it falls outside the safe range. Checking after giving the dose would defeat the safety purpose.

Proper medication storage generally requires that:

• a.Every drug be frozen in the facility freezer to extend its shelf life and potency
• b.Refrigerated drugs be kept at room temperature on the cart so they are ready for the pass
• c.All drugs be kept in a warm, sunny window so that moisture cannot build up in the bottles
• d.Medications be stored as the label directs, some refrigerated or protected from light✓

Medications must be stored according to label directions, including temperature and light requirements, to preserve potency and safety. Some drugs (such as certain insulins) require refrigeration, while others must be protected from light or moisture.

If the aide is unsure whether a medication order is correct or safe, the BEST action is to:

• a.Ask another resident who takes similar pills for advice
• b.Hold the medication and clarify with the nurse before giving✓
• c.Guess based on the resident's other pills and the usual dose
• d.Give the medication and hope the prescriber got it right this time

When any doubt exists about an order's accuracy or safety, the aide holds the dose and clarifies with the licensed nurse before proceeding. Administering a questionable order can cause harm and falls outside safe practice.

A resident's right to privacy during medication administration means the aide should:

• a.Discuss the resident's medications freely with any visitors who ask
• b.Announce all medications loudly in the dining room so others can help
• c.Post the full medication list on the resident's door for staff convenience
• d.Keep medication information confidential and administer discreetly✓

Resident rights include privacy and confidentiality, so medication details are kept private and administration is done discreetly. Sharing health information without authorization violates the resident's rights and privacy laws.

High-alert medication safety often calls for an 'independent double-check,' which means:

• a.The resident checks their own medication and initials the MAR afterward
• b.The second check is skipped when the unit is busy, to save time
• c.The same person checks the drug twice in a row, quickly, before giving it to the resident
• d.A second qualified person separately verifies the drug and dose before it is given✓

An independent double-check has a second qualified staff member verify the medication, dose, and resident separately, catching errors the first person might miss. This is especially important for insulin, anticoagulants, and other high-alert drugs.

A resident's blood pressure medication order has no hold parameter listed, but the resident is very dizzy and pale. The aide should:

• a.Ignore the symptoms and continue the medication pass
• b.Check vital signs and report the symptoms to the nurse before giving✓
• c.Double the dose to stabilize the resident
• d.Give the medication because no parameter is written

Even without a written parameter, new or concerning symptoms like dizziness and pallor warrant checking vital signs and notifying the nurse before administering a blood pressure drug. Safe practice means responding to the resident's condition, not just the written order.

Where state rules and facility policy allow a medication aide to give medications through a G-tube (gastrostomy tube), the aide should:

• a.Push the medication in as fast as possible so the tube does not have time to clog
• b.Give crushed enteric-coated and extended-release tablets routinely through the tube
• c.Mix all of the resident's crushed pills together in one cup and pour them into the tube dry, without water
• d.Flush the tube with water before and after, and give liquid or properly dissolved medications separately✓

Many states do not allow medication aides to give medications through a feeding tube, so the aide first follows state rules and facility policy. Where it is allowed, the tube is flushed with water before and after, and each drug is given separately to prevent clogging and interactions, using liquid forms or tablets the pharmacy confirms may be crushed and dissolved. Enteric-coated and extended-release drugs generally should not be crushed, so the nurse or pharmacist is consulted.

A resident with diabetes has a blood glucose of 55 mg/dL and is shaky and sweating. This indicates hypoglycemia. The aide should FIRST:

• a.Follow protocol to give a fast-acting carbohydrate and notify the nurse✓
• b.Withhold all food and fluids until the nurse arrives
• c.Wait an hour and recheck the glucose before doing anything else
• d.Give the resident's insulin dose immediately

A glucose of 55 with shakiness and sweating signals hypoglycemia, which is treated with a fast-acting carbohydrate (such as juice) per protocol and prompt nurse notification. Giving insulin would dangerously lower the glucose further.

Insulin ordered on a sliding scale means the dose:

• a.Is decided by the aide's judgment of how the resident looks and feels that day
• b.Varies based on the resident's current blood glucose reading per the ordered scale✓
• c.Should be given without checking glucose, since the scale already sets the amount
• d.Is always the same amount

Sliding-scale insulin dosing is determined by the resident's measured blood glucose matched to the prescriber's ordered scale, so glucose must be checked first. Many states do not allow medication aides to give injected insulin; whoever gives it follows the scale exactly and confirms the dose per policy, often with a nurse, because insulin is a high-alert drug.

A resident is ordered a PRN pain medication. Which is the BEST example of correct PRN judgment by the aide?

• a.Give it when the resident reports pain within the ordered dose and interval, then document the response✓
• b.Give it only if the resident is unconscious or cannot ask for it, then record the time given
• c.Withhold it even when the resident meets the ordered criteria, because pain medicine can be habit-forming
• d.Give it on a fixed schedule every few hours regardless of reported pain, so the resident never has to ask

PRN medications are given only when the resident meets the ordered indication (such as reported pain) and within the allowed frequency, followed by documentation of effect. Some states and facilities require a nurse to assess the resident before an aide gives a PRN, so follow your state's rules and facility policy. Giving PRN drugs on a fixed schedule or withholding them when criteria are met are both incorrect.

A resident develops hives, swelling of the lips, and difficulty breathing shortly after a new medication. The aide should:

• a.Recognize a possible severe allergic reaction, stop, get emergency help, and notify the nurse immediately✓
• b.Give another dose of the same medication to help the resident build up a tolerance to it
• c.Document the reaction at the end of the shift only, once the resident has had time to rest
• d.Wait quietly with the resident to see whether the symptoms worsen before telling the nurse or anyone else

Hives, lip swelling, and breathing difficulty suggest a possible anaphylactic reaction, a medical emergency requiring immediate help and nurse notification. Prompt action can be lifesaving, and no further doses are given.

Geriatric (older adult) residents often need extra caution with medications because:

• a.They never experience side effects because their bodies are used to taking medications
• b.They always need much higher doses than younger adults to get the same effect from a drug
• c.Their bodies clear all drugs faster than younger adults
• d.Age-related changes can slow drug metabolism and increase sensitivity and side effects✓

Aging can reduce kidney and liver function and increase sensitivity, so older adults are more prone to drug accumulation and side effects such as dizziness and falls. The aide monitors closely and reports changes, since 'start low, go slow' often applies.

A resident receiving tube feedings is ordered a medication that must be given on an empty stomach. The aide should:

• a.Give it faster through the tube to save time during the pass
• b.Give it mixed into the ongoing feeding bag so it is absorbed slowly over several hours
• c.Skip the medication entirely, because tube-fed residents can never have an empty stomach
• d.Coordinate with the nurse to hold the feeding as ordered and flush the tube appropriately✓

Some medications require holding the tube feeding before and after to ensure absorption, which must be coordinated with the nurse and done with proper flushing. Mixing such a drug into a continuous feeding can reduce its effectiveness.

When should the aide notify the nurse about a resident's response to medication?

• a.For any adverse reaction, lack of improvement, refusal, or value outside a hold parameter✓
• b.Never, since the aide is expected to manage all medication responses alone without nursing help
• c.Only at the annual care-plan review meeting, unless the resident or the family complains first
• d.Only if the resident dies or must be sent to the hospital by ambulance

The aide reports promptly for adverse reactions, lack of expected effect, refusals, or vital signs outside ordered parameters so the nurse can intervene. Timely communication is central to safe medication assistance within the aide's scope.

A resident's finger-stick glucose is 320 mg/dL before a meal. According to good practice, the aide should:

• a.Withhold every one of the resident's scheduled medications until the glucose comes down on its own
• b.Ignore the reading because the resident says they feel fine
• c.Give a fast-acting carbohydrate like juice and recheck in 15 minutes
• d.Follow the facility's protocol for high readings and notify the nurse right away✓

A glucose of 320 is elevated (hyperglycemia), so the aide follows the facility's protocol and the resident's orders for high readings and informs the nurse promptly. Many states do not allow medication aides to give injected insulin, so sliding-scale doses are handled by whoever is permitted. Juice treats low glucose, not high, so recognizing the direction of the imbalance is essential.

A resident who normally swallows pills easily is suddenly coughing and choking while taking oral medication. The aide should:

• a.Give water forcefully to push the pills down before the coughing gets worse
• b.Lay the resident flat immediately and keep giving the remaining pills one at a time
• c.Continue giving the remaining pills quickly so the medication pass stays on schedule
• d.Stop, make sure the airway is clear and the resident is safe, and notify the nurse✓

New coughing and choking may indicate a swallowing (aspiration) problem, so administration is stopped and the resident's safety and airway are the priority before notifying the nurse. Forcing more pills or fluids could worsen aspiration.