Certified Medication Aide (CMA) — All Questions

Before giving a PRN laxative, the medication aide confirms that the resident is constipated, the condition the order names. Which right does this check most directly support?

• a.Right dose
• b.Right reason✓
• c.Right route
• d.Right response

The right reason means the medication is being given for the condition it was ordered for. Right response is the follow-up observation of what the medication did, and route and dose concern how and how much.

Which information is documented each time a transdermal patch is applied?

• a.Only the lot number that is printed on the outside of the box
• b.Nothing extra, as long as the old patch was taken off first
• c.The date, time and site, the way facility policy says✓
• d.Only the resident's pain score before the patch went on

Patch location must match the record, so the date, time and site are documented per facility policy. That record is how the next person finds and removes the old patch.

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.

A PRN order reads: "acetaminophen 650 mg by mouth as needed." Which required parts of a PRN order are missing?

• a.The name of the pharmacy that dispensed the medication
• b.The resident's room number and the bed letter
• c.The brand name of the drug in addition to its generic name
• d.The reason for giving it and the minimum interval between doses✓

A PRN order must name the condition it is for and the minimum time between doses, along with the usual parts of any order. Room numbers, pharmacy names and brand names are not what makes a PRN order complete.

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.

A medication is ordered to be given by the buccal route. Where is it placed?

• a.Under the tongue, then swallowed with water
• b.On top of the tongue, then chewed
• c.In the lower eyelid pocket
• d.Between the cheek and the gum✓

Buccal means between the cheek and the gum, where the tablet dissolves and is absorbed through the lining of the mouth. Sublingual is under the tongue; neither type is chewed or swallowed.

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

The medication aide needs to step into a resident's room, out of sight of the medication cart, for a moment. What should be done with the cart?

• a.Lock it before stepping away✓
• b.Leave it unlocked but push it flat against the wall
• c.Leave the keys on top of it so the nurse can reach them
• d.Ask a resident to watch it

The cart is locked whenever the aide is not standing at it, and keys stay with authorized staff. Medications left unsecured can be taken by the wrong person.

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.

A dose is scheduled at 21:45. What is that in 12-hour time?

• a.9:45 a.m.
• b.11:45 p.m.
• c.7:45 p.m.
• d.9:45 p.m.✓

For 24-hour times above 12:59, subtract 12 to get the p.m. time: 21 − 12 = 9, so 21:45 is 9:45 p.m.

A resident asks for her PRN antacid for heartburn. In this medication aide's state, the licensed nurse must authorize each PRN dose. What should the aide do first?

• a.Give it, then ask the nurse to approve it afterward
• b.Check that 4 hours have passed, then give it without asking
• c.Get the nurse's authorization before giving it✓
• d.Give it, since heartburn is the reason written in the order

The first PRN check is the state and facility rule: where the nurse must assess or authorize each PRN dose, that comes before anything else. Approval after the fact does not meet the rule.

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.

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.

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.

The pharmacy label on a resident's bottle is smeared, and the strength cannot be read. What should the medication aide do?

• a.Give it today and leave a note for the nurse to get it relabeled
• b.Give it, since the MAR already lists the correct strength
• c.Not give from that container, and tell the nurse✓
• d.Rewrite the label neatly using the information on the MAR

If a label is damaged or unreadable, the medication is not given from it and the nurse is told. Aides never relabel containers, and the MAR cannot confirm what is actually in the bottle.

A resident's diet order calls for thickened liquids. Which liquid should the medication aide offer with her tablets?

• a.Thin juice, because pills go down more easily with juice
• b.Thin water, since only a few sips are needed with pills
• c.Whatever she asks for, and tell the nurse if she coughs
• d.Liquid thickened to the consistency in her diet order✓

Only the liquid consistency in the diet order or care plan is used; if thickened liquids are ordered, thin water is not given with medications. If the resident coughs or chokes, the aide stops and tells the nurse.

How is 12:30 a.m. written on a 24-hour clock?

• a.24:30
• b.00:30✓
• c.12:30
• d.13:30

The 12 a.m. hour becomes 00, so 12:30 a.m. is 00:30. 12:30 on a 24-hour clock is half past noon.

A resident asks the medication aide to let her chew her extended-release potassium tablet because it is large. What should the aide do?

• a.Split it with a pill cutter and let the nurse know it was split
• b.Let her chew it, since potassium is a supplement, not a drug
• c.Not let her chew or crush it; tell the nurse, who may get a different form ordered✓
• d.Crush it into applesauce if a pharmacist says it is fine

Extended-release products are never crushed or chewed, and MedlinePlus says extended-release potassium is swallowed whole. If a resident cannot swallow one, the nurse is told; a different form may be ordered.

A coworker initials all of the 09:00 doses on the MAR before starting the medication pass, to save time. How is this best described?

• a.Acceptable, as long as each dose is given within the hour
• b.Acceptable, if any refusals are corrected on the MAR later
• c.Falsification, because the doses are charted before they are given✓
• d.A time-saving method allowed once the nurse approves it

Doses are documented only after the resident takes them. Pre-charting makes the MAR false the moment a resident refuses, is away or the dose is dropped, and no approval makes it acceptable.

The order is 75 mg. The tablets on hand are 50 mg each and are not scored. What should the medication aide do?

• a.Stop and ask the nurse, since 1½ unscored tablets would be needed✓
• b.Break one tablet in half by hand and give 1½ tablets
• c.Give 1 tablet now and note the shortfall for the nurse
• d.Give 2 tablets, since that is the closest whole number

75 ÷ 50 = 1½ tablets. A result that is a fraction of an unscored tablet is a reason to stop and ask the nurse. Rounding, splitting by hand or charting an amount not given are all errors.

A PRN order reads "every 4 hours as needed for pain, no more than 4 doses in 24 hours." The MAR shows doses at 06:00, 10:00, 14:00 and 18:00 today. At 22:30 the resident asks for pain medicine. What should the medication aide do?

• a.Give it, because more than 4 hours have passed since the 18:00 dose
• b.Not give it, because the 24-hour maximum has been reached, and tell the nurse about the pain✓
• c.Give it now and tell the nurse at the end of the shift that it was a fifth dose
• d.Give half of a dose so that the daily total is only slightly over the limit

Before a PRN dose, the aide checks both the interval and any 24-hour maximum. Four doses have already been given in the last 24 hours, so another would exceed the order; the nurse is told about the ongoing pain. Partial doses and late reporting do not fix an over-limit dose.

Which abbreviation means "drops"?

• a.supp
• b.gtt✓
• c.tab
• d.susp

gtt means drop(s). tab means tablet, supp means suppository and susp means suspension.

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.

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.

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 with a fentanyl patch asks for a heating pad over the patch area. What should the medication aide do?

• a.Apply the heating pad on its lowest setting and tell the nurse afterward
• b.Not put heat over the patch, and tell the nurse about the request✓
• c.Offer an electric blanket instead, since it spreads the heat more evenly over the body
• d.Remove the patch, use the heating pad for a while, then put the same patch back

Heat over a patch is avoided unless the label allows it; MedlinePlus warns that heat on a fentanyl patch can release too much drug at once. The nurse is told about the request and the resident's discomfort.

A resident on a fluid restriction drinks 1 cup of water with her medications. How many milliliters should be counted?

• a.180 mL
• b.120 mL
• c.300 mL
• d.240 mL✓

Using the standard household equivalents in 21 CFR 101.9, 1 cup = 240 mL. Water given with medications is counted toward a fluid limit as the care plan directs.21 CFR 101.9

Which lubricant is used when giving a rectal suppository?

• a.Scented hand lotion
• b.No lubricant; it is inserted dry
• c.Petroleum jelly
• d.A water-soluble lubricant✓

A suppository is lubricated with a water-soluble lubricant, not petroleum jelly, and inserted pointed end first, past the internal sphincter. Hand lotion is not a lubricant for this purpose.

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 resident given a sublingual tablet asks for a full glass of water so she can swallow it. What should the medication aide do?

• a.Crush the tablet and stir it into the glass of water
• b.Explain that it should dissolve under the tongue without being swallowed✓
• c.Give the water, since swallowing the tablet works just as well
• d.Have her chew the tablet first so that it dissolves faster

Sublingual tablets are absorbed through the lining of the mouth. The resident is told not to chew, crush or swallow the tablet and to let it dissolve in place, so water is not offered to wash it down.

A medication is scheduled at 07:00 and 19:00. What are those times in 12-hour form?

• a.7:00 a.m. and 9:00 p.m.
• b.9:00 a.m. and 9:00 p.m.
• c.7:00 p.m. and 9:00 a.m.
• d.7:00 a.m. and 7:00 p.m.✓

07:00 is 7:00 a.m. For 19:00, subtract 12: 19 − 12 = 7, so it is 7:00 p.m.

A resident with dementia seems much more confused than usual two days after a medication dose was increased. A coworker says, "That's just her dementia." What should the medication aide do?

• a.Agree, since confusion is expected in a resident with dementia
• b.Wait a week, then tell the nurse if the confusion has not settled
• c.Give her next dose early to calm her down
• d.Report the change to the nurse, since a sudden change can be a medication effect✓

A new or sudden change in confusion can be a medication effect and is reported. It is never assumed to be "just dementia."

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.

Two residents have the same nasal spray ordered. One resident's bottle is empty. May the medication aide use the other resident's bottle?

• a.Yes, if the borrowed dose is documented on both residents' MARs
• b.Yes, if the drug and the strength on both labels are the same
• c.Yes, if the spray tip is wiped clean before and after use
• d.No; each container is used only for its own resident✓

Each resident's container is kept for that resident only, and one resident's supply is never used for another. The aide tells the nurse that the resident's own supply has run out.

Before applying more of an ordered ointment to a resident's skin, what should be done with the old layer?

• a.Rub it in harder so that it absorbs fully before the new layer
• b.Clean it off as directed before applying the new layer✓
• c.Leave it in place and apply a thicker layer on top of it
• d.Cover it with a bandage so that the new layer stays clean and dry

Old topical medication is cleaned off as directed before a new layer is applied, and the medication goes only on the area ordered, in the amount ordered.

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.

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.

Which statement about the medication administration record (MAR) is correct?

• a.It is written by the prescriber, so it does not need to be compared with a label
• b.It is copied from the prescriber's orders, so it can contain a copying error✓
• c.It is a private worksheet and not part of the legal record
• d.It lists only the medications given on the current shift

The MAR is copied from the orders by the nurse or pharmacy, which is one reason the label is compared with the MAR every time. It lists each resident's current orders and is a legal record.

Why does the medication aide wear gloves when applying a medicated cream?

• a.Because creams may only be applied using a sterile technique
• b.Because gloves make the cream absorb into the skin more quickly
• c.So the cream can be spread over broken skin without an order
• d.To avoid absorbing the drug and to protect the resident's skin from contamination✓

Gloves protect the aide from absorbing the drug and protect the resident's skin from contamination. They do not change absorption, creams are not a sterile procedure, and broken skin is treated only if the order says so.

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 calculation for one dose comes out to 8 tablets. What is the best action?

• a.Give 4 tablets now and ask the nurse about the other 4 later
• b.Give 2 tablets and record the dose as given in full on the MAR
• c.Stop and check with the nurse, since a result of more than two or three tablets usually signals an error✓
• d.Give the 8 tablets, because the arithmetic was checked carefully twice and both answers came out exactly the same

If a result is more than two or three tablets, a fraction of an unscored tablet, or an odd volume, stop and ask. A surprising answer almost always means a misread unit, a misplaced decimal or a wrong order.

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.

After placing an eye drop in the lower lid pocket, what helps keep the drop from draining away?

• a.Squeezing the eyelids tightly shut for one full minute
• b.Blinking rapidly several times to spread the drop around
• c.Rubbing the closed eyelid firmly in small circles
• d.Closing the eye gently and pressing lightly on the inner corner✓

MedlinePlus directs the person to close the eye gently for 2 to 3 minutes, without squeezing, while pressing lightly on the tear duct at the inner corner. Squeezing, rapid blinking and rubbing push the drop out.

How should a tablet be taken from a multi-dose bottle during preparation?

• a.Picked out of the bottle with clean, dry bare fingers, one at a time
• b.Poured into the bottle cap, then into the medicine cup✓
• c.Shaken into the palm of the hand, then dropped into the cup
• d.Poured into the cup, with extras returned to the bottle by hand

Tablets are prepared without touching them: pour from the bottle into the cap and then into the cup. Handling tablets with bare hands contaminates them.