Certified Medication Aide (CMA) — All Questions

Furosemide is classified as a diuretic. What is its main therapeutic effect?

• a.Increasing urine output to remove excess fluid✓
• b.Slowing the heart rate directly to reduce workload
• c.Thickening the blood to prevent bleeding after injury
• d.Raising blood sugar levels to give the body energy

Diuretics such as furosemide increase urine production to reduce fluid overload, helping conditions like heart failure and edema. Because they cause fluid and potassium loss, aides watch for dehydration and low potassium symptoms.

Metformin is most commonly prescribed to treat which condition?

• a.Type 2 diabetes✓
• b.High cholesterol
• c.Depression
• d.Bacterial infection

Metformin is an oral antidiabetic that lowers blood glucose, mainly by reducing glucose production in the liver. It treats type 2 diabetes and is not an antibiotic, antidepressant, or cholesterol drug.

A resident takes lisinopril, an ACE inhibitor. Its primary purpose is to:

• a.Relieve constipation
• b.Lower blood pressure✓
• c.Fight fungal infections
• d.Reduce stomach acid

ACE inhibitors such as lisinopril relax blood vessels to lower blood pressure and protect the heart and kidneys. A common side effect is a dry cough, and the aide should monitor blood pressure per orders.

Which class of drugs does the medication 'atorvastatin' belong to, and what does it treat?

• a.Antacid; reduces heartburn
• b.Anticoagulant; thins the blood
• c.Statin; lowers cholesterol✓
• d.Antibiotic; treats infection

Atorvastatin is a statin used to lower LDL ('bad') cholesterol and reduce cardiovascular risk. Muscle aches are a possible side effect that should be reported to the nurse.

Therapeutic effect versus side effect: for a resident taking an antihistamine for allergies, drowsiness is BEST described as:

• a.An allergic reaction to stop the drug
• b.A sign the drug is not working
• c.A common side effect to monitor for safety✓
• d.The intended therapeutic effect

The therapeutic effect of an antihistamine is relief of allergy symptoms, while drowsiness is a common side effect. Side effects are expected but should be monitored, especially for fall risk in older adults.

Warfarin is an anticoagulant. Residents taking it should be monitored for:

• a.Faster wound healing after small cuts or scrapes
• b.Signs of unusual bleeding or bruising✓
• c.Sharper eyesight, especially in dim light
• d.A large increase in appetite and weight

Anticoagulants like warfarin reduce clot formation, so the main risk is bleeding, seen as bruising, bloody urine or stool, or prolonged bleeding. The aide reports any bleeding signs and follows dietary and monitoring orders.

Which of the following is a controlled substance requiring special counting and documentation?

• a.Calcium supplement
• b.Multivitamin
• c.Oxycodone✓
• d.Acetaminophen (plain)

Opioids such as oxycodone are controlled substances under federal law and require secure storage plus a witnessed count and precise documentation. Ordinary over-the-counter items like vitamins are not controlled.Controlled Substances Act

A resident takes levothyroxine. This medication is used to treat:

• a.High blood pressure and fluid retention (edema)
• b.Trouble sleeping (insomnia)
• c.An underactive thyroid (hypothyroidism)✓
• d.Seizures caused by epilepsy

Levothyroxine replaces thyroid hormone in hypothyroidism and is usually taken in the morning on an empty stomach for best absorption. Consistent timing is important for a steady hormone level.

Which drug form dissolves in the mouth and is intended NOT to be swallowed whole?

• a.Suppository
• b.Enteric-coated tablet
• c.Sublingual tablet✓
• d.Extended-release capsule

A sublingual tablet dissolves under the tongue and is absorbed directly, so it should not be chewed or swallowed. Enteric-coated and extended-release forms are meant to be swallowed whole.

Drug interaction: a resident on warfarin is also given a new medication. The aide should be especially alert because interactions may:

• a.Only matter for injectable drugs, not tablets
• b.Increase or decrease warfarin's blood-thinning effect✓
• c.Change the resident's eye color
• d.Have no possible effect on warfarin

Many drugs and even foods high in vitamin K interact with warfarin, either raising bleeding risk or reducing effectiveness. New medications should prompt the aide to watch closely and ensure the nurse is aware of the full drug list.

Acetaminophen is commonly used as an analgesic and antipyretic, meaning it:

• a.Relieves pain and reduces fever✓
• b.Lowers blood pressure and cholesterol
• c.Increases urine and blood sugar
• d.Prevents blood clots and infection

Analgesic means pain-relieving and antipyretic means fever-reducing, which describes acetaminophen. Because high doses can damage the liver, total daily intake from all sources must be tracked.

A beta blocker such as metoprolol primarily works to:

• a.Slow the heart rate and lower blood pressure✓
• b.Raise the heart rate and blood pressure quickly
• c.Increase stomach acid production to improve digestion
• d.Thin nasal secretions and clear congestion quickly

Beta blockers reduce heart rate and blood pressure and the heart's workload, which is why a pulse is often checked before administration. The aide holds the dose and notifies the nurse if the pulse is below the ordered parameter.

Which medication class treats bacterial infections and should be given at evenly spaced times to keep blood levels steady?

• a.Antibiotics✓
• b.Antacids
• c.Antihistamines
• d.Anticoagulants

Antibiotics fight bacterial infections and work best at consistent intervals to maintain effective blood levels. The full course should be completed even if the resident feels better, to prevent resistance.

Omeprazole is a proton pump inhibitor (PPI). Its therapeutic purpose is to:

• a.Treat depression and anxiety symptoms
• b.Reduce stomach acid production✓
• c.Increase blood clotting after surgery
• d.Lower blood glucose after each meal

PPIs like omeprazole decrease stomach acid to treat reflux and ulcers and are often given before the first meal of the day. They are not antidiabetic, anticoagulant, or antidepressant drugs.

A contraindication for a medication means:

• a.A minor warning that can be ignored if the resident agrees
• b.A condition or factor that makes giving the drug unsafe✓
• c.The best reason to give the drug to a resident right away
• d.A recommended higher dose for residents with severe symptoms

A contraindication is a specific situation in which a medication should not be used because harm could result, such as giving a drug to a resident allergic to it. The aide checks allergies and orders and reports any contraindication to the nurse.

Digoxin is used in some heart conditions. Before giving it, the aide typically must:

• a.Give it faster if the resident feels dizzy or lightheaded
• b.Check the resident's weight only and give it if weight is stable
• c.Check the blood glucose and hold if it is above 200
• d.Check the apical pulse and hold if it is below the ordered rate✓

Digoxin slows and strengthens the heartbeat, so an apical pulse is counted for a full minute and the dose is held, with nurse notification, if the pulse is below the rate written in the order. Nausea, visual changes, and a slow pulse can signal digoxin toxicity.

A resident takes an antidepressant in the SSRI class. These medications:

• a.Work instantly, within minutes of the first dose
• b.Are controlled narcotics
• c.Should be stopped suddenly when the resident feels better
• d.May take several weeks to reach full effect✓

SSRIs treat depression and typically require two to several weeks for full benefit, so consistent daily dosing matters. They should not be stopped abruptly, and the aide reports mood changes to the nurse.

Which is an example of a drug's 'side effect' rather than its therapeutic effect?

• a.Reduced fever from acetaminophen
• b.Constipation from an opioid pain medication✓
• c.Lower blood pressure from an antihypertensive
• d.Pain relief from an opioid pain medication

The therapeutic effect is the intended benefit (pain relief), while constipation is a common unintended side effect of opioids. Recognizing side effects helps the aide monitor residents and report problems.

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.

A resident takes lisinopril, an ACE inhibitor. Which finding is the most urgent to report?

• a.A blood pressure reading within the care-plan range
• b.A dry, tickly cough that started last month
• c.A normal breakfast
• d.New swelling of the lips and tongue✓

Swelling of the face, lips, tongue or throat with an ACE inhibitor is reported at once; MedlinePlus says to call the doctor immediately. A cough is a known, less urgent side effect, and a normal reading or appetite is not a problem.

A resident now needs more of a pain medication to get the same relief she once got from a smaller dose. What is this called?

• a.Toxicity
• b.Tolerance✓
• c.Idiosyncratic reaction
• d.Dependence

Tolerance means needing more of a drug over time for the same effect. Dependence shows up as withdrawal when the drug stops suddenly, and toxicity is harm from too much drug.

Which albuterol side effect does MedlinePlus say to call the doctor about at once?

• a.Mild shakiness that fades after a little while
• b.A bad taste in the mouth after use
• c.A fast, pounding or irregular heartbeat✓
• d.Feeling a little nervous after a puff

MedlinePlus lists shaking and nervousness as albuterol side effects, but says to call the doctor at once for a fast, pounding or irregular heartbeat.

Which effect in a resident taking donepezil does MedlinePlus say to call the doctor about at once?

• a.A slightly smaller appetite
• b.Mild nausea after the dose
• c.Fainting or a slow heartbeat✓
• d.A brief, loose stool once

For donepezil, MedlinePlus lists nausea, vomiting, diarrhea, loss of appetite and dizziness as side effects, and says to call the doctor at once for fainting or a slow heartbeat.

Which side effects does MedlinePlus list for metformin, to report if they are severe or do not go away?

• a.Yellow vision and a slow heartbeat
• b.A dry cough and a hoarse voice
• c.Swelling of the ankles and feet
• d.Diarrhea, nausea and stomach discomfort✓

For metformin, MedlinePlus lists stomach side effects such as diarrhea, nausea and stomach discomfort to report if they are severe or persistent. Yellow vision is linked to digoxin and a dry cough to ACE inhibitors.

A resident taking warfarin asks about leafy green vegetables, which are high in vitamin K. Which advice matches MedlinePlus?

• a.Keep the amount eaten consistent from week to week✓
• b.Stop eating leafy green vegetables entirely
• c.Eat extra greens to make the warfarin work better
• d.Eat greens only on days when no dose is due

MedlinePlus advises eating consistent amounts of vitamin K-containing foods from week to week and not eating large amounts of leafy greens. The goal is consistency, not avoiding them.

Nystatin ends in "-statin." What kind of medication is it?

• a.A beta blocker for blood pressure
• b.An anticoagulant that thins the blood
• c.A cholesterol-lowering statin
• d.An antifungal✓

Nystatin is an antifungal, an exception to the -statin pattern. Cholesterol-lowering statins include atorvastatin.

Why does the medication aide keep track of acetaminophen from every source a resident receives?

• a.It thins the blood the same way warfarin does, so each dose raises the risk of bleeding
• b.Too much can cause severe liver damage, and many combination products contain it✓
• c.It is a controlled substance that must be counted at each shift change
• d.It causes kidney stones when given with water

Too much acetaminophen can cause severe liver damage, so the total daily amount from all products matters, including combination products. PRN doses are tracked carefully.

Which statement about latanoprost eye drops for glaucoma is correct?

• a.They cure glaucoma within a few weeks, after which they can be stopped
• b.They are used only when the resident reports eye pain
• c.They are given in the same minute as any other eye drops ordered, so the resident only has to sit through one round of drops
• d.They control glaucoma but do not cure it, so they are continued even when the resident feels well✓

MedlinePlus says latanoprost controls glaucoma but does not cure it, is continued even when the person feels well, and is given at least 5 minutes before or after other eye drops.

A resident who takes apixaban, an anticoagulant, slips and bumps her head. She says she feels fine and has no visible injury. What should the medication aide do?

• a.Make no report, because there is no visible injury
• b.Have her lie down for an hour, then decide whether to report it
• c.Report the fall to the nurse right away, mentioning the anticoagulant✓
• d.Hold her next apixaban dose and tell the nurse about the fall at shift end

With an anticoagulant the main danger is bleeding, so any fall, especially with a blow to the head, is reported, even without visible injury. Holding a dose is not the aide's decision, and waiting delays assessment.

Why is every ordered dose of an antiseizure medication such as levetiracetam given on schedule?

• a.Missing a dose causes a dangerous rise in blood pressure
• b.Stopping it suddenly can make seizures worse✓
• c.It is an antibiotic that must be finished in full
• d.Extra doses are needed later if one is missed

MedlinePlus warns that stopping levetiracetam or phenytoin suddenly can make seizures worse, so every dose is given as ordered. Any seizure activity, drowsiness or unsteadiness is reported.

A resident is having a sudden asthma attack. Which type of inhaler is meant to relieve it?

• a.An inhaled corticosteroid such as fluticasone
• b.An antihistamine tablet such as loratadine
• c.A cough suppressant such as dextromethorphan
• d.A quick-relief bronchodilator such as albuterol✓

A quick-relief (rescue) bronchodilator opens the airways. MedlinePlus says inhaled corticosteroids help prevent attacks but will not stop one that has started. Breathing trouble is also reported to the nurse at once.

A resident who takes iron tablets has black stools that are not tarry and not streaked with red. What does MedlinePlus say about this?

• a.Black stools are normal with iron tablets; tarry or red-streaked stools are reported✓
• b.It is a sign of an allergic reaction to the iron tablets
• c.It is a sure sign of bleeding in the stomach and is an emergency
• d.It means the iron is not being absorbed and should be doubled

MedlinePlus says black stools are normal with iron tablets, but stools that are tarry or streaked with red are reported. Iron can also cause constipation, diarrhea or stomach upset.

How is an omeprazole delayed-release tablet usually given?

• a.At bedtime, chewed so it works faster
• b.Before a meal, swallowed whole✓
• c.With a snack, split in half on a scored line
• d.After a meal, crushed into applesauce

Omeprazole is usually taken before a meal, following the label and MAR, and MedlinePlus tells patients to swallow delayed-release tablets whole without crushing or chewing.

Which change in a resident recently started on sertraline should be reported to the nurse?

• a.New thoughts of self-harm or worsening depression✓
• b.Eating meals at the usual times each day
• c.Feeling slightly better after several weeks
• d.Taking the tablet at the time on the MAR

MedlinePlus warns that antidepressants may increase suicidal thinking. New or worsening depression, thoughts of self-harm, agitation, new anxiety or trouble sleeping are reported. Gradual improvement over weeks is expected.

Which side effect is specifically listed for statins such as atorvastatin as one to report?

• a.White patches in the mouth, as with steroid inhalers
• b.Yellow or blurred vision, as with the heart drug digoxin
• c.A dry, tickly cough, as with ACE inhibitors such as lisinopril
• d.Unexplained muscle pain, tenderness or weakness✓

For statins, unexplained muscle pain, tenderness or weakness is reported. The other options are signature side effects of different drug classes.

Why might the MAR schedule calcium carbonate several hours apart from levothyroxine?

• a.Calcium makes levothyroxine act as a blood thinner
• b.The two together cause severe drowsiness and falls
• c.Levothyroxine destroys calcium before it reaches the bones
• d.Calcium can reduce how much levothyroxine is absorbed✓

Antacids, calcium and iron can reduce the absorption of some drugs such as levothyroxine; MedlinePlus says calcium carbonate and iron should be taken at least 4 hours before or after it. That is why the MAR spaces them apart.

A resident who uses a fluticasone inhaler has painful white patches in her mouth. What might this be?

• a.Food stuck to the gums that needs no report
• b.Thrush, a side effect that should be reported✓
• c.A sign she needs a second puff each time
• d.A normal sign that the inhaler is working

MedlinePlus lists steroid inhalers among the causes of thrush, and painful white patches in the mouth or throat as a fluticasone side effect to report. Rinsing and spitting after use helps prevent it.

A resident has just started tamsulosin for an enlarged prostate. Which precaution fits this medication?

• a.Help him get up slowly, since he may feel dizzy or faint on rising✓
• b.Crush it into food, since it works better when crushed
• c.Give it with grapefruit juice so that it absorbs faster
• d.Encourage him to stand up quickly to improve his blood flow

Tamsulosin can cause dizziness, lightheadedness or fainting, especially when getting up too quickly from lying down. Residents are helped to stand slowly, and dizziness or falls are reported.

Which finding should be reported for a resident who takes carbidopa-levodopa for Parkinson's disease?

• a.Being able to button a shirt more easily in the morning
• b.Walking more steadily than before the medication started
• c.Taking the medication at the times ordered on the MAR
• d.New uncontrolled movements of the face, mouth, arms or legs✓

For carbidopa-levodopa, report dizziness or fainting on standing, confusion, hallucinations, or new uncontrolled movements. Improved movement is the intended effect.

How is alendronate taken?

• a.On rising, with a full glass of plain water, at least 30 minutes before the first food, drink or other medicine✓
• b.With breakfast and a glass of milk to protect the stomach, then lying down to rest
• c.With the other morning pills and a cup of coffee, then sitting for 5 minutes
• d.At bedtime with orange juice, then lying flat so it stays in the stomach

Alendronate is taken right after getting up with a full glass of plain water, at least 30 minutes before the first food, drink or other medicine, and the person does not lie down for at least 30 minutes and until after the first food of the day.

Which finding most suggests an allergic reaction rather than an ordinary side effect?

• a.A dry mouth during the afternoon
• b.Hives with swelling of the face✓
• c.Mild nausea after taking the dose
• d.Drowsiness about an hour after a dose

Hives and swelling suggest an allergic reaction, which is reported to the nurse immediately; trouble breathing or throat swelling is an emergency. Nausea, dry mouth and drowsiness are usually side effects, which are also reported.

MedlinePlus says diphenhydramine generally should not be used in older adults except for which purpose?

• a.Serious allergic reactions✓
• b.Occasional trouble falling asleep
• c.Mild itching from dry skin
• d.A mild cold with a runny nose

MedlinePlus says diphenhydramine generally should not be used in older adults except for serious allergic reactions. It causes drowsiness and dry mouth, and the CDC lists antihistamines among drugs that can cause dizziness and confusion.

Which finding should be reported for a resident taking amoxicillin?

• a.Feeling better on the third day
• b.Taking each dose on time
• c.A rash or watery, frequent diarrhea✓
• d.A fever that is going down

For antibiotics, rash, hives, swelling or trouble breathing (possible allergic reaction) and watery or frequent diarrhea are reported. Improving symptoms show the antibiotic working.