Certified Medication Aide (CMA) — All Questions

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.

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.

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.

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.

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 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.

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)

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 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.

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.

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.

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.

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 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 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.

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.

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.

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.