Certified Medication Aide (CMA) — All Questions

Where state rules and facility policy allow a medication aide to give medications through a G-tube (gastrostomy tube), the aide should:

• a.Push the medication in as fast as possible so the tube does not have time to clog
• b.Give crushed enteric-coated and extended-release tablets routinely through the tube
• c.Mix all of the resident's crushed pills together in one cup and pour them into the tube dry, without water
• d.Flush the tube with water before and after, and give liquid or properly dissolved medications separately✓

Many states do not allow medication aides to give medications through a feeding tube, so the aide first follows state rules and facility policy. Where it is allowed, the tube is flushed with water before and after, and each drug is given separately to prevent clogging and interactions, using liquid forms or tablets the pharmacy confirms may be crushed and dissolved. Enteric-coated and extended-release drugs generally should not be crushed, so the nurse or pharmacist is consulted.

A resident with diabetes has a blood glucose of 55 mg/dL and is shaky and sweating. This indicates hypoglycemia. The aide should FIRST:

• a.Follow protocol to give a fast-acting carbohydrate and notify the nurse✓
• b.Withhold all food and fluids until the nurse arrives
• c.Wait an hour and recheck the glucose before doing anything else
• d.Give the resident's insulin dose immediately

A glucose of 55 with shakiness and sweating signals hypoglycemia, which is treated with a fast-acting carbohydrate (such as juice) per protocol and prompt nurse notification. Giving insulin would dangerously lower the glucose further.

Insulin ordered on a sliding scale means the dose:

• a.Is decided by the aide's judgment of how the resident looks and feels that day
• b.Varies based on the resident's current blood glucose reading per the ordered scale✓
• c.Should be given without checking glucose, since the scale already sets the amount
• d.Is always the same amount

Sliding-scale insulin dosing is determined by the resident's measured blood glucose matched to the prescriber's ordered scale, so glucose must be checked first. Many states do not allow medication aides to give injected insulin; whoever gives it follows the scale exactly and confirms the dose per policy, often with a nurse, because insulin is a high-alert drug.

A resident is ordered a PRN pain medication. Which is the BEST example of correct PRN judgment by the aide?

• a.Give it when the resident reports pain within the ordered dose and interval, then document the response✓
• b.Give it only if the resident is unconscious or cannot ask for it, then record the time given
• c.Withhold it even when the resident meets the ordered criteria, because pain medicine can be habit-forming
• d.Give it on a fixed schedule every few hours regardless of reported pain, so the resident never has to ask

PRN medications are given only when the resident meets the ordered indication (such as reported pain) and within the allowed frequency, followed by documentation of effect. Some states and facilities require a nurse to assess the resident before an aide gives a PRN, so follow your state's rules and facility policy. Giving PRN drugs on a fixed schedule or withholding them when criteria are met are both incorrect.

A resident develops hives, swelling of the lips, and difficulty breathing shortly after a new medication. The aide should:

• a.Recognize a possible severe allergic reaction, stop, get emergency help, and notify the nurse immediately✓
• b.Give another dose of the same medication to help the resident build up a tolerance to it
• c.Document the reaction at the end of the shift only, once the resident has had time to rest
• d.Wait quietly with the resident to see whether the symptoms worsen before telling the nurse or anyone else

Hives, lip swelling, and breathing difficulty suggest a possible anaphylactic reaction, a medical emergency requiring immediate help and nurse notification. Prompt action can be lifesaving, and no further doses are given.

Geriatric (older adult) residents often need extra caution with medications because:

• a.They never experience side effects because their bodies are used to taking medications
• b.They always need much higher doses than younger adults to get the same effect from a drug
• c.Their bodies clear all drugs faster than younger adults
• d.Age-related changes can slow drug metabolism and increase sensitivity and side effects✓

Aging can reduce kidney and liver function and increase sensitivity, so older adults are more prone to drug accumulation and side effects such as dizziness and falls. The aide monitors closely and reports changes, since 'start low, go slow' often applies.

A resident receiving tube feedings is ordered a medication that must be given on an empty stomach. The aide should:

• a.Give it faster through the tube to save time during the pass
• b.Give it mixed into the ongoing feeding bag so it is absorbed slowly over several hours
• c.Skip the medication entirely, because tube-fed residents can never have an empty stomach
• d.Coordinate with the nurse to hold the feeding as ordered and flush the tube appropriately✓

Some medications require holding the tube feeding before and after to ensure absorption, which must be coordinated with the nurse and done with proper flushing. Mixing such a drug into a continuous feeding can reduce its effectiveness.

When should the aide notify the nurse about a resident's response to medication?

• a.For any adverse reaction, lack of improvement, refusal, or value outside a hold parameter✓
• b.Never, since the aide is expected to manage all medication responses alone without nursing help
• c.Only at the annual care-plan review meeting, unless the resident or the family complains first
• d.Only if the resident dies or must be sent to the hospital by ambulance

The aide reports promptly for adverse reactions, lack of expected effect, refusals, or vital signs outside ordered parameters so the nurse can intervene. Timely communication is central to safe medication assistance within the aide's scope.

A resident's finger-stick glucose is 320 mg/dL before a meal. According to good practice, the aide should:

• a.Withhold every one of the resident's scheduled medications until the glucose comes down on its own
• b.Ignore the reading because the resident says they feel fine
• c.Give a fast-acting carbohydrate like juice and recheck in 15 minutes
• d.Follow the facility's protocol for high readings and notify the nurse right away✓

A glucose of 320 is elevated (hyperglycemia), so the aide follows the facility's protocol and the resident's orders for high readings and informs the nurse promptly. Many states do not allow medication aides to give injected insulin, so sliding-scale doses are handled by whoever is permitted. Juice treats low glucose, not high, so recognizing the direction of the imbalance is essential.

A resident who normally swallows pills easily is suddenly coughing and choking while taking oral medication. The aide should:

• a.Give water forcefully to push the pills down before the coughing gets worse
• b.Lay the resident flat immediately and keep giving the remaining pills one at a time
• c.Continue giving the remaining pills quickly so the medication pass stays on schedule
• d.Stop, make sure the airway is clear and the resident is safe, and notify the nurse✓

New coughing and choking may indicate a swallowing (aspiration) problem, so administration is stopped and the resident's safety and airway are the priority before notifying the nurse. Forcing more pills or fluids could worsen aspiration.

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.

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 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 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 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.

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.

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.

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 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.

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.

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.

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 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.

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.