Certified Medication Aide (CMA) — All Questions

The order is 40 mg of a liquid. The label reads 20 mg per 5 mL. Which volume matches the order?

• a.2 mL
• b.0.5 mL
• c.10 mL✓
• d.20 mL

(40 ÷ 20) × 5 mL = 10 mL. Because the amount differs from the label's 5 mL, it is confirmed with the nurse and state rules before giving.

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.

During a medication pass, which practice helps prevent mix-ups between residents?

• a.Pouring several residents' doses ahead of time to save steps
• b.Preparing and giving medications for one resident at a time✓
• c.Labeling poured cups with room numbers and setting them aside
• d.Carrying two residents' cups together when they share a room

One resident at a time, with the three label checks and two identifiers, is a basic error-prevention habit. Pre-pouring and carrying multiple residents' cups invite wrong-resident errors.

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.

A resident has a seizure during the medication pass. What should the medication aide do?

• a.Give her next antiseizure dose early, then tell the nurse
• b.Keep her safe from injury and get the nurse immediately✓
• c.Hold her arms and legs down firmly until the jerking stops
• d.Place a spoon in her mouth so she cannot bite her tongue

A seizure is an emergency: keep the resident safe and get the nurse at once. Nothing is placed in the mouth, the person is not restrained, and medications are not given early or by mouth during a seizure.

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.

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.

A resident's daily fluid limit is 1.5 L. How many milliliters is that?

• a.1,500 mL✓
• b.150 mL
• c.15 mL
• d.15,000 mL

1 L = 1,000 mL, so 1.5 L × 1,000 = 1,500 mL.

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.

Amlodipine is a calcium channel blocker. Which side effect is listed for this group?

• a.Black, tarry stools and bleeding gums
• b.Swelling of the hands, feet, ankles or lower legs✓
• c.A dry, persistent cough
• d.Painful white patches inside the mouth or on the tongue

Calcium channel blockers such as amlodipine can cause swelling of the hands, feet, ankles or lower legs, and dizziness. Black stools, a dry cough and mouth thrush point to other causes.

Which approach helps a resident with mild swallowing difficulty take tablets safely?

• a.Recline her slightly so that the pills slide down more easily
• b.Crush each tablet into applesauce without checking which can be crushed
• c.Sit her upright and give one tablet at a time, with liquid as her diet order allows✓
• d.Give the tablets together at once with a large gulp of water

For swallowing difficulty, the resident sits upright, takes one tablet at a time, and uses only the liquid consistency in her diet order. Each product is checked before any crushing, and coughing or choking means stop and tell the nurse.

A resident has reduced kidney function. Why does this matter for medications?

• a.The resident will need higher doses of most drugs
• b.Drugs removed by the kidneys can build up in the body✓
• c.Oral medications will work only if they are crushed
• d.Drugs will no longer be absorbed from the intestines

If the kidneys or liver work less well, a drug can build up, which is why the prescriber may adjust doses and why the aide watches for signs of too much drug.

Which organ does most of the work of metabolizing (changing) drugs in the body?

• a.The stomach
• b.The liver✓
• c.The lungs
• d.The kidneys

Metabolism happens mainly in the liver, which changes drugs into forms that are easier to remove. The kidneys handle most excretion.

A coworker forgot her eMAR password and asks the medication aide to chart the doses she gave under the aide's login. What should the aide do?

• a.Chart them, since the aide watched the doses being given
• b.Chart them under the aide's login and add a note saying who gave them
• c.Let the coworker use the aide's login to chart them herself
• d.Decline; each person documents only the doses they gave✓

Every person charts only the doses they personally gave, and nobody charts for anyone else. Sharing a login also makes the record show the wrong person.

A resident has an order to take a crushable tablet mixed in applesauce. Which statement about giving it is correct?

• a.The resident should not be told, so she does not refuse to eat the applesauce
• b.A day's doses can be mixed into one bowl of applesauce each morning
• c.The resident must know that the medication is in the applesauce✓
• d.The applesauce can be left at the bedside so she can eat it later when she feels hungry

Mixing medication with food needs an order or facility approval, and the resident must know the medication is in it; hiding it is not allowed. Doses are prepared at the time given and the aide stays until it is taken.

A resident refuses a tablet, and facility policy allows a later offer within the time window. What may be offered later?

• a.The same tablet, kept in a labeled cup on top of the cart
• b.A freshly prepared dose, not the tablet that was poured and refused✓
• c.The same tablet, left in the resident's bedside drawer
• d.Two tablets at the next pass so that the dose is made up

A refused dose is disposed of or returned as policy says and is never kept loose to give later; any later offer is a newly prepared dose within the allowed window. Doubling up at the next pass changes the order.

The order is 0.1 mg. The tablets on hand are labeled 50 mcg each. Which amount matches the order?

• a.1 tablet
• b.20 tablets
• c.2 tablets✓
• d.1/2 tablet

Convert first: 0.1 mg = 100 mcg. Then 100 ÷ 50 = 2 tablets. Because the order and the label strength differ, this is checked with the nurse before giving.

A resident receives a scheduled laxative. Which finding should the medication aide report?

• a.Diarrhea, abdominal pain or no bowel movement✓
• b.A soft, formed bowel movement the next morning
• c.A normal appetite at both lunch and dinner today
• d.Sleeping through the whole night without waking

For laxatives and stool softeners, bowel movements are recorded as the facility requires, and diarrhea, abdominal pain or no bowel movement is reported. A soft, formed stool shows the medication working.

A drug name ends in "-lol," as in carvedilol. Which drug class does this usually indicate?

• a.ACE inhibitor
• b.Proton pump inhibitor
• c.Beta blocker✓
• d.Cholesterol-lowering statin

Beta blocker names usually end in -lol (metoprolol, carvedilol). ACE inhibitors end in -pril, statins in -statin and proton pump inhibitors in -prazole.

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.

During the pass, a resident suddenly has slurred speech and weakness in one arm. What should the medication aide do?

• a.Give her scheduled pills first and check on her again later
• b.Treat it as an emergency and get the nurse immediately✓
• c.Write it down and report it to the nurse at shift change
• d.Let her rest in bed and recheck her at the next medication pass

Sudden weakness on one side or slurred speech needs immediate action. Waiting, or giving oral medications to a resident whose speech and swallowing may be affected, is unsafe.

A resident who received an opioid an hour ago cannot be woken and is breathing with long pauses. What should the medication aide do?

• a.Check on him again at the next medication pass in two hours
• b.Treat it as an emergency and get the nurse immediately✓
• c.Note it on the MAR and tell the nurse at the end of the shift
• d.Let him sleep, since this shows the pain medicine is working

Slowed breathing or long pauses between breaths are opioid effects to report, and a resident who cannot be woken is treated as an emergency.

The medication aide reported a resident's dizziness to the nurse an hour ago. The resident now seems worse. What should the aide do?

• a.Assume the nurse is handling it, since it was already reported
• b.Ask family to call the doctor
• c.Report the change to the nurse again✓
• d.Write it in the notes and wait for the next shift

Reporting includes follow-up: if a resident gets worse after a report, the aide reports again. Reports go to the licensed nurse, not to family.

A resident is NPO after midnight for a procedure, and oral medications are due at 06:00. What should the medication aide do?

• a.Check with the nurse before giving anything by mouth✓
• b.Give the pills crushed in applesauce instead of with water
• c.Give the pills with a small sip of water and let the nurse know afterward
• d.Give the pills as usual, because NPO applies only to meals

NPO means nothing by mouth. The aide does not decide which medications to give or hold; the nurse is asked for direction before anything is given by mouth.

Where state rules allow a medication aide to give a vaginal cream, how is the resident positioned?

• a.Standing and leaning forward against the bed
• b.Lying face down on the bed
• c.Sitting upright in a chair
• d.On her back with her knees bent✓

For vaginal medications, the resident lies on her back with knees bent, with privacy provided, gloves worn and the supplied applicator used as the product directs.

Which sequence of steps at the bedside is correct?

• a.Explain the medication, give it, document it, then identify the resident
• b.Document the dose, identify the resident, give it, then explain it
• c.Give the medication first, identify the resident, document it, then explain it
• d.Identify the resident, explain the medication, give it, then document it✓

The resident is identified first, the medication is explained, it is given and swallowed, and only then is it documented. Charting before giving or identifying after giving defeats the purpose of each step.

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.

A resident with dementia keeps refusing her morning tablet. A coworker suggests hiding it in her pudding. What should the medication aide do?

• a.Hide it in the pudding and tell the nurse afterward so it is charted
• b.Decline, document the refusal and tell the nurse✓
• c.Crush it into her juice and stay with her until she finishes it
• d.Hide it in the pudding, since the medication is for her own good

A resident has the right to refuse, and hiding medication in food or drink without an order and the resident's knowledge is not allowed. The refusal is documented and reported to the nurse.

A resident who takes risperidone has new movements of the lips and tongue that she cannot control. What may this be?

• a.A sign of low blood glucose that needs juice
• b.A normal part of aging that needs no report
• c.A possible sign of tardive dyskinesia that should be reported✓
• d.A sign that the medication is working better

The FDA label describes uncontrolled movements of the face, lips or tongue as possible signs of tardive dyskinesia, which are reported. A change like this is never assumed to be normal aging.

Why must prednisone not be stopped or skipped unless the prescriber orders it?

• a.It is a blood thinner, and missing a dose causes clots
• b.Stopping it suddenly can leave the body short of its own steroids✓
• c.It is a Schedule II drug, so skipped doses must be counted
• d.It is an antibiotic, so the full course must be finished on schedule

MedlinePlus warns that stopping prednisone suddenly can leave the body short of its own steroids. Prednisone is a corticosteroid that reduces inflammation, not an antibiotic, anticoagulant or controlled substance.

Which device is best for measuring 2.5 mL of an oral liquid medication?

• a.An oral syringe marked in mL✓
• b.A dropper from a different product
• c.A teaspoon from the dining room
• d.A cup marked only in tablespoons

Oral syringes are used for small or exact amounts. The FDA tells consumers not to use a kitchen spoon or a dosing device from a different product.

A new order on the MAR lists the drug, dose, route and time, but there is no prescriber signature or electronic authentication. What should the medication aide do?

• a.Hold the dose and report the incomplete order to the nurse✓
• b.Give the dose, since the pharmacy has already filled and labeled the prescription
• c.Phone the prescriber's office directly to confirm the order, then give the dose
• d.Give the first dose and leave a note asking the nurse to get the order signed later

A complete order includes the prescriber's signature or electronic authentication. When any part is missing, the aide does not give the medication and reports it to the nurse, who clarifies orders. A filled prescription does not complete the order, and contacting the prescriber directly is generally not the aide's role.

A resident has just started zolpidem for sleep. What is the main safety concern the medication aide watches for?

• a.Swelling of the ankles and feet after several days of use
• b.Drowsiness, confusion and unsteadiness that raise fall risk✓
• c.A faster heartbeat and a higher blood pressure in the morning
• d.Low blood glucose with heavy sweating in the middle of the night

Sedatives and sleep medications can cause drowsiness, confusion and unsteadiness, which raise the risk of falls in older adults. Morning drowsiness or unsteadiness is reported.

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.

A resident has a daily fluid restriction in her care plan. How is the water given with her medications handled?

• a.It is increased so that the pills dissolve faster in the stomach
• b.It is replaced with juice, which does not count toward the limit
• c.It is counted toward her limit as the care plan directs✓
• d.It is left out of the total, because it is part of taking medicine

Some residents have a daily fluid limit, and the water given with medications is counted as the care plan directs.

About how far is a rectal suppository inserted in an adult?

• a.About 1 inch, past the internal sphincter✓
• b.Just inside the opening of the anus
• c.About 6 inches, as far as it will go
• d.About half an inch, then held in place

MedlinePlus says to insert the suppository past the muscular sphincter of the rectum, about 1 inch in an adult. If it is not past the sphincter it may be pushed back out.

Which side effects are most common with sublingual nitroglycerin, according to the FDA label?

• a.Constipation and drowsiness
• b.Headache and dizziness✓
• c.Dry cough and hoarseness
• d.Muscle pain and weakness

Headache and dizziness are the most common side effects on the FDA label, and MedlinePlus says the person will probably be told to sit down before taking a dose.

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.

Which drink is acceptable to take with alendronate?

• a.Orange juice
• b.Mineral water
• c.Plain water✓
• d.Milk

MedlinePlus says alendronate is taken only with plain water, never milk, juice or mineral water, which can interfere with it.

Which group of signs suggests low blood glucose in a resident who takes insulin?

• a.Yellow or blurred vision and loss of appetite
• b.Thirst with frequent urination over several days
• c.A dry cough with swelling of the lips
• d.Shakiness, sweating, fast heartbeat and confusion✓

The CDC lists fast heartbeat, shaking, sweating, nervousness, irritability or confusion, dizziness and hunger as signs of low blood glucose. These are reported to the nurse immediately and the facility's hypoglycemia procedure is followed.

A resident takes naproxen, an NSAID. Which finding should be reported?

• a.Black, tarry stools or stomach pain✓
• b.Walking farther than usual without pain
• c.Taking the dose with food or milk
• d.Less joint stiffness than last week

NSAIDs can cause ulcers and bleeding in the stomach or intestine without warning. Black or tarry stools, stomach pain, or vomit that is bloody or looks like coffee grounds are reported. Less pain shows the drug working.

An auxiliary label on a tube reads "for external use only." What does this mean?

• a.It may be applied only by a pharmacist and not by an aide or nurse
• b.It may be swallowed as long as it is taken with a meal or snack
• c.It may be used only when the resident is outside the facility
• d.Apply it to the outside of the body; it is not swallowed✓

"For external use only" means the product is for the skin or outside of the body, not to be taken by mouth. Auxiliary labels are read and followed along with the MAR.

Aspirin and clopidogrel are antiplatelet medications. What should the medication aide watch for and report?

• a.Swelling in the ankles at the end of the day
• b.A dry cough that keeps the resident awake
• c.Signs of bleeding such as bruising, nosebleeds or black stools✓
• d.Low blood glucose with shakiness and sweating

Antiplatelets raise bleeding risk, so the same bleeding signs as for anticoagulants are reported: unusual bruising, bleeding gums, nosebleeds, blood in urine, and black or tarry stools.

When is levothyroxine generally taken?

• a.At bedtime with a small snack and a glass of milk
• b.On an empty stomach, 30 minutes to 1 hour before breakfast✓
• c.Together with an antacid to protect the stomach
• d.With breakfast and a calcium supplement, at the same time each day

Levothyroxine is taken on an empty stomach, 30 minutes to 1 hour before breakfast, and separated from calcium, iron and antacids. Follow the times on the MAR.

How is an eye ointment applied?

• a.Into the tear duct at the inner corner of the eye
• b.As a thin ribbon into the pocket made by pulling down the lower lid✓
• c.Directly onto the center of the eyeball, then blinked in
• d.Onto the skin of the upper eyelid

MedlinePlus describes eye ointment applied as a thin ribbon into the pocket formed by gently pulling down the lower lid. It is not placed on the cornea, the eyelid skin or the tear duct.

A resident weighs 132 pounds. About how many kilograms is that?

• a.60 kg✓
• b.132 kg
• c.290 kg
• d.66 kg

1 kg is about 2.2 lb, so divide pounds by 2.2: 132 ÷ 2.2 = 60 kg. Dividing by 2 gives 66, and multiplying by 2.2 goes the wrong way.

The order is 125 mg of a liquid. The label reads 250 mg per 5 mL. Which volume matches the order?

• a.5 mL
• b.2.5 mL✓
• c.0.25 mL
• d.10 mL

(125 ÷ 250) × 5 mL = 0.5 × 5 mL = 2.5 mL, measured in an oral syringe marked in mL.

The order is 300 mg of a liquid. The label reads 100 mg per 5 mL. Which volume matches the order?

• a.1.5 mL
• b.30 mL
• c.5 mL
• d.15 mL✓

(300 ÷ 100) × 5 mL = 3 × 5 mL = 15 mL. An amount this different from the label is confirmed with the nurse first.

Which complaint from a resident who takes furosemide should be reported to the nurse?

• a.Feeling rested and eating a full breakfast
• b.Passing more urine in the hours after the morning dose
• c.Thirst, weakness and muscle cramps✓
• d.Sleeping well through the night without waking

MedlinePlus tells people taking furosemide to report dry mouth, thirst, weakness, muscle pain or cramps, confusion, or a rapid or pounding heartbeat. Increased urine output is the intended effect of a diuretic.