Certified Medication Aide (CMA) — All Questions

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.

A resident with diabetes who takes glipizide eats nothing at breakfast. What should the medication aide do before her scheduled dose?

• a.Give half of the dose, since she ate only half as much as usual
• b.Tell the nurse before giving it, and give it only as the nurse directs✓
• c.Give it as scheduled, since the dose is already on the MAR
• d.Skip the dose and tell the nurse about it at the end of the shift

A resident who is not eating is reported to the nurse before insulin or a diabetes pill such as glipizide is given, because these medications given to someone who does not eat can lead to low blood glucose. The aide does not change or skip the dose alone.

A resident asks the medication aide to leave her pills on the breakfast tray so she can take them after she eats. There is no order for self-administration. What should the aide do?

• a.Stay until she takes them, or bring them back when she is ready✓
• b.Leave them with her roommate, who has kindly offered to remind her to take them
• c.Leave them on the tray and come back later to check that the cup is empty
• d.Leave them and chart them as given, since she has agreed to take them after eating

The aide stays until the medication is swallowed. Medications are not left at the bedside unless an order and facility assessment allow self-administration, and doses are charted only after they are taken.

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.

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.

How is 4:15 p.m. written on a 24-hour clock?

• a.04:15
• b.15:15
• c.14:15
• d.16:15✓

From 1:00 to 11:59 p.m., add 12 to the hour: 4 + 12 = 16, so 4:15 p.m. is 16:15. 04:15 would be 4:15 a.m.

Convert 3 mg to micrograms.

• a.30,000 mcg
• b.300 mcg
• c.3,000 mcg✓
• d.30 mcg

Going from mg to mcg, the number gets bigger: 3 × 1,000 = 3,000 mcg.

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.

How many milligrams of drug are in 1 teaspoon of a suspension labeled 125 mg per 5 mL?

• a.62.5 mg
• b.25 mg
• c.125 mg✓
• d.250 mg

1 teaspoon = 5 mL, and the label says 5 mL contains 125 mg. The liquid is still measured with a device marked in mL, not a kitchen spoon.

Why does a paper MAR include a signature section?

• a.So every set of initials can be traced to the person who gave the dose✓
• b.So family members can approve changes to the orders
• c.So the pharmacy can confirm delivery of each card
• d.So the resident can sign for each medication received

Initials need a signature on file so every entry can be traced to a specific person. Residents, the pharmacy and family do not sign the MAR to approve doses or orders.

During a survey, 40 opportunities for error are observed and 2 errors are found. What is the medication error rate, and does it meet the federal requirement?

• a.2%, which comfortably meets the less-than-5% requirement
• b.5%, which does not meet the less-than-5% requirement✓
• c.5%, which meets the requirement because 5% is allowed
• d.20%, which is far above the less-than-5% federal limit

The rate is errors ÷ opportunities × 100: 2 ÷ 40 × 100 = 5%. Federal rules require a rate of less than 5 percent, so 5% does not meet it.42 CFR 483.45(f)

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.

A resident weighs 50 kg. About how many pounds is that?

• a.110 lb✓
• b.100 lb
• c.52 lb
• d.22.7 lb

1 kg is about 2.2 lb, so multiply kilograms by 2.2: 50 × 2.2 = 110 lb.

How is 12:15 p.m. written on a 24-hour clock?

• a.13:15
• b.00:15
• c.12:15✓
• d.24:15

The 12 p.m. hour stays as it is, so 12:15 p.m. is 12:15. Only 1:00 to 11:59 p.m. add 12 to the hour.

Convert 500 mcg to milligrams.

• a.5 mg
• b.50 mg
• c.0.05 mg
• d.0.5 mg✓

Going from a smaller unit to a larger one, divide by 1,000: 500 ÷ 1,000 = 0.5 mg. Written with a leading zero, never as .5 mg.

Before instilling ear drops, how should the bottle be prepared?

• a.Chilled in the medication refrigerator so the drops feel soothing
• b.Warmed to near body temperature by holding it in the hand for a few minutes✓
• c.Heated in a microwave for a few seconds until it is warm
• d.Held under hot running tap water until it is hot to the touch

MedlinePlus says to warm ear drops to near body temperature by holding the bottle in the hand for a few minutes. Chilling the drops, microwaving the bottle or using hot tap water are not the method it gives.

A tablet ordered to be given sublingually is instead swallowed with a glass of water. Which right was not followed?

• a.Right documentation
• b.Right time
• c.Right route✓
• d.Right resident

The route is how the medication enters the body. A sublingual tablet is meant to dissolve under the tongue, so swallowing it is a wrong-route error even when the drug, dose and time are correct.

A resident vomits 10 minutes after taking her morning tablets, and one tablet is visible. What should the medication aide do?

• a.Tell the nurse and document what happened, without giving more until the nurse directs✓
• b.Rinse the visible tablet under the tap and give it to her again right away
• c.Give a new set of the same tablets right away and tell the nurse
• d.Chart the doses as given and give a double dose at the next pass

Vomiting is reported to the nurse and documented as policy directs. The aide never fixes a dosing problem alone by repeating or doubling doses.

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.

Converting from grams to milligrams, which way does the number change?

• a.It gets 1,000 times bigger✓
• b.It gets 1,000 times smaller
• c.It gets 100 times bigger
• d.It stays the same

1 g = 1,000 mg, so a larger unit converted to a smaller one is multiplied by 1,000. For example, 0.5 g = 500 mg.

Why should a medication aide document a dose as soon as possible after the resident takes it?

• a.So another staff member does not give the same dose again✓
• b.So the nurse can co-sign each entry before the shift is over
• c.So the pharmacy can bill for the dose on the same day it was given
• d.Because the MAR closes to new entries when the medication pass ends

Prompt documentation shows the dose was given, which prevents someone else from giving it a second time. Billing, MAR closing times and nurse co-signatures are not the reason for this rule.

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 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.

A resident is away at a medical appointment during the 12:00 medication pass. How should the missed dose be handled?

• a.Initial the MAR box as given so the day's record stays complete and has no gaps
• b.Leave the MAR box blank and add the tablet to the resident's 17:00 medications
• c.Document it with the facility's code for a dose not given and tell the nurse✓
• d.Send the tablet with the family to give at the appointment and then tell the nurse

A dose not given is recorded with the code or note the facility uses, with the reason, and the nurse is told. Doubling it up later changes the order, charting it as given is falsification, and medications are not handed to family to give.

How many teaspoons are in 1 tablespoon?

• a.2
• b.3✓
• c.4
• d.5

1 teaspoon = 5 mL and 1 tablespoon = 15 mL, so 3 teaspoons make 1 tablespoon.

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.

How many milliliters are in 2 fluid ounces?

• a.30 mL
• b.15 mL
• c.120 mL
• d.60 mL✓

1 fluid ounce = 30 mL, so 2 fluid ounces = 60 mL.

The MAR lists a resident's medication by its generic name, but the pharmacy label shows only a brand name the medication aide does not recognize. What should the aide do?

• a.Hold it, document it as refused, and let the nurse order a new supply
• b.Search the brand name on a personal phone and give it if it seems to match
• c.Ask the nurse to confirm the label and the MAR are the same drug before giving it✓
• d.Give it, because the pharmacy label is more reliable than the MAR

A pharmacy may dispense a different name for the same drug, so the label is compared with the MAR using both names, and the nurse is asked when the label name is not the name on the MAR. Guessing from an internet search or charting a false refusal is unsafe.

An order reads "acetaminophen suppository 650 mg PR." What does PR mean?

• a.By mouth
• b.As needed
• c.At bedtime
• d.By rectum✓

PR means by rectum. By mouth is PO, as needed is prn, and bedtime is written as the facility approves (ISMP accepts QHS or qhs).

After giving a resident her PRN pain medicine at 13:00, what must the medication aide record later, when facility policy directs?

• a.The result: whether the pain improved✓
• b.The name of the pharmacy that filled it
• c.The time the next scheduled meal is served
• d.The resident's room temperature at 13:00

A PRN dose needs the reason, the time and, later, the result. Leaving out whether the medication worked leaves the PRN entry incomplete.

For reference, federal nursing-home surveyors count a wrong-time error when a dose is given how far from its scheduled time, if the timing could harm the resident?

• a.240 or more minutes earlier or later
• b.60 or more minutes earlier or later✓
• c.15 or more minutes earlier or later
• d.30 or more minutes earlier or later

The CMS State Operations Manual counts a wrong-time error at 60 or more minutes off schedule when the timing could cause discomfort or harm. The facility's own written policy sets the exact window staff must follow.CMS State Operations Manual, Appendix PP (F759/F760)

Which report to the nurse is the most useful?

• a."Mr. Diaz seems a bit off today, not like his usual self."
• b."Mr. Diaz is being difficult again this morning."
• c."I think Mr. Diaz has food poisoning from lunch."
• d."Mr. Diaz vomited twice since 10:00 and said, 'My stomach hurts.'"✓

Good reports give facts, not guesses: what was seen, when it started and the resident's own words. Diagnosing and vague labels do not help the nurse assess the resident.

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.

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.

Convert 0.25 mg to micrograms.

• a.250 mcg✓
• b.2,500 mcg
• c.2.5 mcg
• d.25 mcg

1 mg = 1,000 mcg. Going from a larger unit to a smaller one, multiply by 1,000: 0.25 × 1,000 = 250 mcg.

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

A resident takes scheduled acetaminophen. Her family brings an over-the-counter cold medicine that also contains acetaminophen and asks the aide to give it. What should the medication aide do?

• a.Not give it; ask them to give it to the nurse, since it needs an order and duplicates acetaminophen✓
• b.Give half of the cold medicine and record the half dose on the MAR
• c.Give it, because cold medicines are sold without a prescription at any pharmacy
• d.Give it, then ask the nurse to skip her next acetaminophen dose

Nothing is given without an order, and a cold product containing acetaminophen on top of scheduled acetaminophen is duplicate therapy, which risks liver damage. The family gives it to the nurse.

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 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 quick-relief (beta-agonist) inhaler such as albuterol is ordered as 2 puffs. Following MedlinePlus, what is done between puffs?

• a.Give the second puff immediately with no pause
• b.Wait 30 minutes before giving the second puff
• c.Rinse the inhaler mouthpiece before the second puff
• d.Wait 1 to 2 minutes before the next puff✓

For quick-relief beta-agonist medicine, MedlinePlus says to wait 1 to 2 minutes before the next puff; for other inhaled medicines, no wait is needed. Follow the device's own instructions too.

A resident developed a new rash after yesterday's first dose of an antibiotic, and the next dose is due now. What should the medication aide do?

• a.Give it, because antibiotics have to be finished in full
• b.Give it, then tell the nurse about the rash afterward
• c.Give it with a leftover antihistamine from the cart
• d.Hold the dose and tell the nurse before giving it✓

When a side effect or reaction is suspected, the next dose of the suspected cause is not given until the nurse decides. A rash can be an allergic reaction, which is reported.

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.

A resident tells the medication aide she has chest pain. She has a PRN nitroglycerin order. What should the aide do first?

• a.Tell the nurse immediately✓
• b.Give her an antacid
• c.Give three tablets at once and then tell the nurse
• d.Wait 15 minutes to see whether the pain passes on its own

For a resident with chest pain, the nurse is told immediately: new or unrelieved chest pain is an emergency. The aide's role in giving PRN nitroglycerin is set by state and facility rules, and doses are never improvised.

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.

A medication is ordered "stat." When is it given?

• a.Only when the resident asks
• b.Each day at the same time
• c.Immediately, one time✓
• d.At bedtime each night

A stat order is given immediately, once. In many settings stat orders are handled by the nurse. As-needed is prn, and a scheduled daily dose is a routine order.

An order reads "q6h" and the medication is given around the clock. How many doses is that in 24 hours?

• a.6
• b.2
• c.4✓
• d.3

q6h means every 6 hours. Twenty-four hours divided by 6 gives 4 doses a day.

Which way of asking a resident to confirm identity is the most reliable?

• a."You're Mrs. Lee, aren't you?"
• b."Are you the resident who lives in room 12, bed B?"
• c."Please tell me your full name and your date of birth."✓
• d."Is this the seat where you usually sit for lunch?"

The resident is asked to state their own name and date of birth, which are then matched to the MAR. A confused or hard-of-hearing resident may say yes to any name, and room, bed or seat location never identifies a resident.

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.

A resident's antibiotic order had an automatic stop date of yesterday, but tablets are still on the cart. What should the medication aide do?

• a.Not give it, and tell the nurse✓
• b.Give the tablets until the card is empty so that nothing is wasted
• c.Give it, and ask the nurse to renew the order before the next dose
• d.Give it and write "continued" next to the stop date on the MAR

An expired order is not given, even if medication remains on the cart. The nurse is told so any needed order can be clarified. The aide cannot extend an order.