Certified Medication Aide (CMA) — All Questions

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.

Which task requires nursing judgment and should not be done by a medication aide?

• a.Deciding whether a resident needs a medication the order leaves to clinical judgment✓
• b.Giving a routine tablet exactly as it is ordered on the MAR, at the scheduled time, after checking the label
• c.Reporting a resident's new rash to the nurse promptly
• d.Documenting a dose on the MAR right after it is taken

Assessing a resident or deciding whether a medication is needed when the order leaves it to judgment is outside the aide's role. Giving ordered medications, documenting and reporting are within it.

Why is "U" for unit on The Joint Commission's official "Do Not Use" list?

• a.It is too long to fit on a label
• b.It means "under the tongue"
• c.It can be mistaken for 0, 4 or "cc"✓
• d.It refers only to injectable drugs

"U" can be misread as 0, 4 or "cc", turning 10 units into 100 or 40. The word "unit" is written out instead.

Which schedule of controlled substances has no currently accepted medical use in treatment in the United States?

• a.Schedule IV
• b.Schedule II
• c.Schedule V
• d.Schedule I✓

Schedule I drugs, such as heroin, have a high potential for abuse and no currently accepted medical use. Schedules II through V have accepted medical uses, with abuse potential decreasing down the list.21 U.S.C. 812; 21 CFR Part 1308

An order is written as "5.0 mg." What error could this cause?

• a.It could be read as 5 mL
• b.It could be read as 5 mcg
• c.It could be read as 0.5 mg
• d.It could be read as 50 mg✓

A trailing zero is on The Joint Commission's Do Not Use list because a missed decimal point turns 5.0 mg into 50 mg. The correct form is 5 mg.

A medication aide gave a resident an extra dose of her blood pressure pill. A coworker suggests skipping the next dose to "even it out." What is correct?

• a.Report the extra dose to the nurse now; skipping a dose would be a second error✓
• b.Give the next dose as usual and say nothing, since the resident seems fine
• c.Skip the next dose, since the total for the day will then be right
• d.Skip the next dose and mention it to the nurse at the next care-plan meeting

An error is reported to the nurse immediately, whether or not harm is seen. Trying to fix it alone, for example by skipping the next dose, creates a second error.

A liquid medication that is normally clear looks cloudy today. What should the medication aide do?

• a.Strain it, then give it
• b.Not give it, and report it✓
• c.Shake it hard until it looks clear, then give it
• d.Give it, since it is still within its expiration date

Anything that looks wrong, such as a changed color, a cloudy liquid that should be clear, crumbled tablets or a broken seal, is reported and not given.

In a nursing home, a PRN order for a psychotropic drug that is not an antipsychotic, such as lorazepam, is limited to 14 days unless what happens?

• a.The pharmacy sends a new supply before the 14 days end
• b.The prescriber documents why a longer period is appropriate✓
• c.The medication aide notes that the resident still needs it
• d.The resident's family asks for the order to continue

Federal rules limit PRN psychotropic orders to 14 days unless the prescriber documents the reason for a longer period. PRN antipsychotics need a new evaluation before they can be ordered again. An expired order is not given; tell the nurse.42 CFR 483.45(e)

A medication aide withholds a resident's PRN pain medicine because the resident was rude earlier. How is this best described?

• a.A form of abuse or neglect✓
• b.Acceptable if it is documented
• c.A decision within the aide's judgment
• d.Acceptable behavior management

Withholding a medication to punish or control a resident is a form of abuse or neglect. Documenting it does not make it acceptable.

A scheduled dose was not given and was not documented as refused or held. What type of medication error is this?

• a.Omission✓
• b.Wrong drug
• c.Wrong resident
• d.Wrong route

An omission error is a scheduled dose not given and not documented as refused or held. It is reported like any other error.

Which statement about a medication error (incident) report is correct?

• a.It is a quality and safety tool, generally kept separate from the medical record✓
• b.It is filed in the resident's chart for family to read
• c.It is completed only if the resident was visibly harmed by the error
• d.It replaces the need to tell the nurse about the error once it is filled out

The incident or medication error report is a quality and safety tool that facilities generally keep separate from the medical record, as policy directs. It is completed in addition to reporting to the nurse, harm or not.

Why does the ISMP print some drug names with capital letters, such as hydrOXYzine and hydrALAZINE?

• a.To show which drugs are controlled substances
• b.To mark brand names apart from generic names
• c.To show which part of the name is pronounced
• d.To help staff tell look-alike names apart✓

These "tall man" letters highlight the parts of look-alike names that differ. Staff still read the whole name, strength and purpose and compare it with the MAR.

Why is "MSO4" on The Joint Commission's "Do Not Use" list?

• a.It is the brand name of a drug that is no longer sold
• b.It stands for a route that medication aides may not use
• c.It can be confused between morphine sulfate and magnesium sulfate✓
• d.It means "may skip one dose" and is easily ignored

MS, MSO4 and MgSO4 are confused with each other, mixing up morphine sulfate and magnesium sulfate. The full drug names are written instead.

At the shift-change count, the outgoing staff member says, "The count is always right, just sign the sheet." What should the medication aide do?

• a.Sign it to save time
• b.Count together before signing✓
• c.Sign it, since the count has been correct for the whole week
• d.Sign it now and recount alone after the other person leaves

The controlled-substance count is done by two authorized people together, and both sign. Signing without counting defeats the purpose of the count.

A nursing-home resident wants to keep and use her own inhaler. When may she self-administer it?

• a.Whenever she asks, because residents have the right to keep any medication
• b.At no time, because nursing-home residents may not self-administer
• c.Only after her family signs a form taking responsibility for it
• d.When the interdisciplinary team has determined it is clinically appropriate✓

Residents have the right to self-administer medications if the interdisciplinary team has determined it is clinically appropriate, and they keep the medications as the care plan and policy direct.42 CFR 483.10(c)(7)

Which statement about medication aide permissions across states is correct?

• a.Each state sets its own rules, so permissions in one state do not carry over to another✓
• b.An aide certified in any state may do the same tasks in any other state
• c.The testing company decides which routes aides may use in each state
• d.One national scope of practice applies the same way across the country

Medication aides are certified by states, and states differ on routes, controlled substances, PRN rules, vital signs and calculations. An aide who moves assumes nothing carries over until the new state's board says so.

For which resident is delegating medication administration to a medication aide least appropriate?

• a.A resident whose condition is unstable and changing✓
• b.A resident who takes the same scheduled tablets each day
• c.A resident whose orders have not changed in months
• d.A resident whose condition is stable with routine oral medications

A nurse can delegate only to a trained, certified aide, within state rules, for a resident whose condition is stable. An unstable resident needs nursing judgment, which cannot be delegated.

A resident's daughter tells the medication aide to stop giving her mother's sleeping pill. What should the aide do?

• a.Give half of the usual dose until the daughter talks with the doctor
• b.Stop giving the pill, since family members know the resident best
• c.Explain the aide cannot change orders, tell the nurse, and follow the MAR until the order changes✓
• d.Stop giving the pill and tell the nurse about it at the end of the week

Family members can share useful information, but they do not give orders, and the aide cannot change one. The nurse is told promptly, and the MAR as written remains the order until it is changed.

Which of these medications is a Schedule II controlled substance?

• a.Fentanyl✓
• b.Alprazolam
• c.Tramadol
• d.Pregabalin

Fentanyl is Schedule II, along with oxycodone, hydrocodone and morphine. Alprazolam and tramadol are Schedule IV, and pregabalin is Schedule V.21 CFR 1308.12

According to FDA guidance for medicines at home, which medicines may be flushed down the toilet when a take-back option is not readily available?

• a.Any liquid medicine, but not tablets or capsules
• b.Any medicine in a small amount
• c.Only medicines on the FDA flush list✓
• d.Any medicine that has expired

The FDA says to flush only medicines on its flush list, and only when a take-back option is not readily available. Medicines not on the list are not flushed. Facilities follow their own procedures.FDA, Drug Disposal: FDA's Flush List for Certain Medicines

A medication aide wants to post online about a resident's unusual reaction to a new medication, without using the resident's name. Is this appropriate?

• a.Yes, if the post is shared only with friends and coworkers
• b.Yes, as long as the resident's name is left out of the post
• c.No; a resident's medication information is not shared on social media✓
• d.Yes, if the resident's family says that they do not mind

A resident's medications and diagnoses are protected health information, discussed only with people involved in their care and never on social media.

While preparing it, the medication aide drops a resident's controlled-substance tablet on the floor. The aide's state allows aides to give it. What should happen?

• a.It is wasted with an authorized witness and documented, and a new dose is prepared✓
• b.It is picked up and given, since it landed on a clean floor
• c.It is thrown in the trash, and the count is fixed at the end of the shift
• d.It is put back into the blister card to be given tomorrow

A dropped tablet is discarded, documented and replaced. A controlled substance that is dropped or refused is wasted in front of an authorized witness, and both document it.

A nurse delegates the 17:00 medication pass to a medication aide, who then becomes too ill to finish it. What should the aide do?

• a.Ask another aide to finish it and tell the nurse once it is done
• b.Take a long break and finish the pass two hours later
• c.Hand the cart keys to a nursing assistant to finish the pass
• d.Tell the nurse so the nurse can reassign the task✓

A delegated task cannot be handed on to someone else; if the aide cannot finish it, the nurse is told. Re-delegating to a coworker, even with a later report, and giving doses late are both wrong.

A used fentanyl patch is removed in a nursing facility, in a state that lets the medication aide handle it. How is it disposed of?

• a.Folded and flushed down the resident's toilet, following the home instructions for patients
• b.Stuck to the back of the MAR page as proof that it was removed on time
• c.Dropped into the regular trash can in the resident's room, wrapped in a paper towel so no one touches it
• d.Folded sticky sides together and wasted under the facility's controlled-substance procedure, usually with a witness✓

Fentanyl is Schedule II, so in a facility a used patch is controlled-substance waste handled under the facility's procedure, usually with a witness. The "flush, never the garbage" advice from MedlinePlus and the FDA flush list is home guidance for patients.

A resident's new supply of a medication has not arrived from the pharmacy. Another resident has the same drug and strength. What should the medication aide do?

• a.Not borrow it; tell the nurse the dose is unavailable✓
• b.Borrow one dose and record the loan on both residents' MARs
• c.Borrow one dose, then tell the nurse later that it was borrowed
• d.Borrow one dose and replace it when the delivery comes

One resident's medication is never used for another, even "to borrow until the pharmacy delivers." The nurse is told that the dose is not available.

An order reads "Give .25 mg." Why is this written incorrectly?

• a.Only gram amounts may be written with a decimal point
• b.Decimal points are not allowed on any medication order
• c.It should be written as .250 mg so it is easier to read
• d.Without a leading zero, it can be misread as 25 mg✓

A missing leading zero is on the Do Not Use list because the decimal point can be missed: .25 mg read as 25 mg is a hundredfold overdose. It is written 0.25 mg. If an order is unclear, ask the nurse.

The medication aide sees a coworker slip a resident's oxycodone tablet into her own pocket. What should the aide do?

• a.Say nothing, because it is not the aide's business
• b.Ask the coworker privately to put it back next time
• c.Mention it to the nurse casually at the end of the week
• d.Report it to the nurse or supervisor at once✓

Taking a resident's medication is drug diversion, a crime. It is reported at once so it can be investigated. Keeping quiet or handling it privately protects no one.