QMA Insulin Qualified Medication Aide Exam — Questions and Answers

Question 1: A resident who uses an insulin pen leaves the needle attached after injection. The QMA should explain that this can cause:

Reduced hypoglycemia risk
Insulin leakage or air entering the cartridge (Correct answer)
Faster insulin absorption
Stronger insulin potency

Correct answer: Insulin leakage or air entering the cartridge

Leaving a needle attached allows insulin to leak out or air to enter the cartridge, affecting subsequent dose accuracy.

Question 2: Which statement about hypoglycemia unawareness is CORRECT?

It means the resident is faking their symptoms
It only occurs in newly diagnosed diabetics
It is caused exclusively by over-eating carbohydrates
Long-term diabetics may lose the ability to recognize early warning symptoms (Correct answer)

Correct answer: Long-term diabetics may lose the ability to recognize early warning symptoms

Hypoglycemia unawareness is common in long-standing diabetes because repeated low glucose episodes blunt the body's counter-regulatory hormone response and symptom recognition.

Question 3: A QMA uses a lancet to perform a finger stick. After the procedure, the used lancet should be:

Immediately disposed of in a sharps container (Correct answer)
Left on the bedside table until the end of the shift
Recapped and kept for reuse on the same resident
Placed in the regular trash

Correct answer: Immediately disposed of in a sharps container

Used lancets are sharps and must be immediately discarded in an approved sharps container to prevent needlestick injuries.

Question 4: Which report must a QMA complete if a resident receives insulin intended for a different resident?

No report is needed if no harm occurred
A dietary incident form
A medication error/incident report and immediate nurse notification (Correct answer)
Only a verbal report at shift change

Correct answer: A medication error/incident report and immediate nurse notification

Any medication error, including wrong-patient incidents, requires an incident report and immediate nurse notification regardless of whether harm is apparent.

Question 5: After administering insulin, a resident develops shakiness and diaphoresis. What must the QMA document FIRST?

Observed signs and symptoms, time of onset, and actions taken (Correct answer)
Only the insulin dose given; symptoms are the nurse's responsibility
The incident on the next available shift's notes
The resident's meal preferences

Correct answer: Observed signs and symptoms, time of onset, and actions taken

Signs of hypoglycemia after insulin must be documented immediately, including symptoms observed, time, interventions, and nurse notification.

Question 6: Which of the following is the preferred injection site for insulin absorption in most patients?

Buttocks
Outer thigh
Abdomen (Correct answer)
Upper arm

Correct answer: Abdomen

The abdomen provides the fastest and most consistent insulin absorption due to its large surface area and abundant subcutaneous fat.

Question 7: What is the primary purpose of the training program for insulin administration in a QMA course?

To teach the QMA to monitor blood sugar levels
To ensure the QMA knows how to administer insulin safely and correctly (Correct answer)
To train the QMA to prescribe insulin dosa
To provide the QMA with a medical diagnosis

Correct answer: To ensure the QMA knows how to administer insulin safely and correctly

The primary purpose of the insulin administration training program for QMAs is to equip them with the knowledge and skills to administer insulin safely and accurately. This includes understanding proper injection techniques, recognizing potential complications, and adhering to strict protocols. The training is crucial for patient safety and effective diabetes management.

Question 8: When monitoring a resident after insulin injection, which vital sign change would MOST concern the QMA regarding hypoglycemia?

Respiratory rate of 16 breaths per minute
Blood pressure of 118/76 mmHg
Heart rate increasing to 110 bpm with diaphoresis (Correct answer)
Temperature of 98.6°F

Correct answer: Heart rate increasing to 110 bpm with diaphoresis

Tachycardia (elevated heart rate) combined with diaphoresis (sweating) are classic autonomic signs of hypoglycemia requiring immediate action.

Question 9: Which of the following is a key characteristic of long-acting insulin?

It is injected only once a week
It works quickly to reduce blood sugar after meals
It is used to provide basal insulin coverage for 24 hours (Correct answer)
It is only used for type 1 diabetes

Correct answer: It is used to provide basal insulin coverage for 24 hours

Long-acting insulin is characterized by its slow onset and prolonged duration of action, providing a steady, continuous release of insulin over approximately 24 hours. Its primary purpose is to provide basal insulin coverage, which helps maintain stable blood sugar levels between meals and overnight. This type of insulin does not directly address post-meal spikes.

Question 10: Which of the following is the most important piece of information the QMA should document after managing a hypoglycemic episode?

The brand of glucose tablets used
Blood glucose level before and after treatment, treatment given, time, and resident response (Correct answer)
The resident's full medical history
The name of the nurse who was notified

Correct answer: Blood glucose level before and after treatment, treatment given, time, and resident response

Accurate documentation of the glucose readings, treatment administered, timing, and resident response provides an essential clinical record for ongoing care.

Question 11: A resident refuses their scheduled insulin injection. The QMA's first response should be to:

Administer the injection without consent
Persuade the resident by explaining the injection won't hurt
Skip the dose and say nothing until the next scheduled time
Document the refusal and notify the supervising nurse (Correct answer)

Correct answer: Document the refusal and notify the supervising nurse

Patient refusal must be documented and reported to the nurse so the care team can address the situation and ensure patient safety.

Question 12: A QMA makes a documentation error in the paper medication record. The correct procedure is to:

Tear out the page and start over
Scribble out the error completely
Draw a single line through the error, initial it, and write the correct entry (Correct answer)
Use correction fluid to cover the mistake

Correct answer: Draw a single line through the error, initial it, and write the correct entry

A single line through the error with initials maintains a legal record while correcting the mistake; correction fluid destroys the record's legal integrity.

Question 13: How should a QMA dispose of a used insulin syringe after administration?

Place it uncapped directly into a puncture-resistant sharps container (Correct answer)
Recap the needle and place it in the regular trash
Flush the syringe down the toilet
Break the needle off the syringe before disposal

Correct answer: Place it uncapped directly into a puncture-resistant sharps container

Used insulin syringes must be placed uncapped into an approved puncture-resistant sharps container immediately after use to prevent needlestick injuries.

Question 14: What is the QMA's responsibility if they believe a nurse's insulin order contains a potential error?

Correct the order in the MAR themselves
Administer the dose since the nurse is licensed and responsible
Refuse to give any medications that day
Raise the concern with the nurse before administering and seek clarification (Correct answer)

Correct answer: Raise the concern with the nurse before administering and seek clarification

QMAs have a professional duty to question orders they believe may be erroneous and must seek clarification before administering any potentially incorrect dose.

Question 15: Which type of diabetes mellitus is most strongly associated with obesity and insulin resistance?

Maturity-onset diabetes of the young (MODY)
Type 2 diabetes (Correct answer)
Type 1 diabetes
Gestational diabetes

Correct answer: Type 2 diabetes

Type 2 diabetes is strongly linked to excess body weight, physical inactivity, and insulin resistance, where the body cannot use insulin effectively.

Question 16: Which of the following is a long-term complication of poorly controlled hyperglycemia in diabetic patients?

Rapid weight gain from water retention
Peripheral neuropathy and retinopathy (Correct answer)
Seizures from low blood sugar
Immediate loss of consciousness

Correct answer: Peripheral neuropathy and retinopathy

Chronic hyperglycemia damages blood vessels and nerves, leading to long-term complications such as peripheral neuropathy and retinopathy.

Question 17: Which of the following is the correct technique for administering a subcutaneous insulin injection?

Inject insulin into a muscle
Inject insulin into the abdominal muscle
Inject insulin into a vein at a 45-degree angle
Pinch the skin and inject at a 90-degree angle into fatty tissue (Correct answer)

Correct answer: Pinch the skin and inject at a 90-degree angle into fatty tissue

Subcutaneous insulin injections are administered into the fatty tissue just beneath the skin, not into a vein or muscle. Pinching the skin helps to lift this subcutaneous layer, and injecting at a 90-degree angle ensures the needle reaches the correct depth for proper absorption. This technique minimizes pain and reduces the risk of injecting too deeply or too shallowly.

Question 18: Which of the following is typically part of a QMA’s training when learning to administer insulin?

Proper needle disposal (Correct answer)
Diagnosis of insulin-related conditions
Administering insulin intravenously
Performing surgeries

Correct answer: Proper needle disposal

A crucial part of a QMA's training for insulin administration involves learning proper needle disposal techniques. This is essential for preventing accidental needle sticks, reducing the risk of infection, and ensuring compliance with biohazard waste regulations. Safe disposal protects both the QMA and others from potential harm.

Question 19: What does 'delegation' mean in the context of QMA insulin administration?

The physician transfers prescribing authority to the QMA
The facility administrator assigns the task to reduce nursing costs
A licensed nurse formally authorizes the QMA to perform a specific nursing task (Correct answer)
The QMA independently decides to take over insulin duties

Correct answer: A licensed nurse formally authorizes the QMA to perform a specific nursing task

Delegation is the formal transfer of authority from a licensed nurse to the QMA to perform a specific task while the nurse retains accountability.

Question 20: Which body site has the FASTEST absorption rate for subcutaneous insulin?

Thigh
Upper arm
Buttocks
Abdomen (Correct answer)

Correct answer: Abdomen

The abdomen has the fastest and most consistent insulin absorption rate among subcutaneous injection sites.

Question 21: A resident has a new order for insulin. A registered nurse (RN) has completed the initial assessment. Before the QMA can administer insulin to this resident for the first time, what must occur?

The QMA must take a refresher course on insulin administration.
The resident's family must provide written consent for a QMA to administer insulin.
The physician must personally observe the QMA's technique.
The QMA must be directly supervised by the RN during the administration. (Correct answer)

Correct answer: The QMA must be directly supervised by the RN during the administration.

The regulations state that prior to a QMA administering insulin, the task must be delegated by an RN based on an assessment of the QMA's competency, OR the QMA must be supervised by an RN during the administration. This ensures patient safety and verifies the QMA's ability to perform the task correctly for that specific resident.

Question 22: A QMA is preparing insulin and draws up more than the prescribed dose by mistake before administering. What is the correct response?

Administer the excess amount since it is only slightly more
Discard the syringe, prepare a correct dose, and notify the nurse about the near-miss (Correct answer)
Document nothing if the error is corrected before administration
Push out the excess from the syringe and administer the remainder

Correct answer: Discard the syringe, prepare a correct dose, and notify the nurse about the near-miss

Even a near-miss error should be reported to the nurse and the syringe discarded to ensure patient safety and maintain transparency.

Question 23: Which needle length is most commonly used for subcutaneous insulin injection in adults of average build?

4–6 mm pen needle (Correct answer)
1.5 inch (38 mm)
1/2 inch (12.7 mm)
1 inch (25.4 mm)

Correct answer: 4–6 mm pen needle

Short 4–6 mm pen needles are recommended for most adults to reliably target the subcutaneous layer without reaching muscle.

Question 24: Which element is typically included in the written examination component of QMA insulin accreditation?

Pharmacokinetics, hypoglycemia/hyperglycemia recognition, and safe administration procedures (Correct answer)
How to modify a physician's insulin order independently
Marketing information about insulin brands
Financial billing codes for insulin products

Correct answer: Pharmacokinetics, hypoglycemia/hyperglycemia recognition, and safe administration procedures

Written exams for QMA insulin accreditation cover pharmacokinetics, recognizing and responding to blood glucose emergencies, and correct administration procedures.

Question 25: Which statement about continuing education for QMA insulin accreditation is accurate?

Continuing education requirements are set by the individual QMA, not the state
QMAs only need continuing education if they make a medication error
Continuing education updates the QMA's knowledge and is required for recertification in most states (Correct answer)
Continuing education is optional once initial certification is obtained

Correct answer: Continuing education updates the QMA's knowledge and is required for recertification in most states

Most states require ongoing continuing education as a condition of recertification to ensure QMAs remain current with best practices and updated protocols.

Question 26: Exercise affects insulin absorption when insulin is injected into the thigh. What effect does exercise of the legs have?

It has no effect on absorption
It speeds up absorption from the thigh (Correct answer)
It causes insulin to degrade faster
It slows absorption from the thigh

Correct answer: It speeds up absorption from the thigh

Exercise increases blood flow to active muscles, which accelerates insulin absorption from the thigh injection site.

Question 27: When using a U-100 insulin syringe to draw up 22 units of insulin, the QMA should fill the syringe to the:

22 cc mark
22 mL mark
22 unit mark (Correct answer)
0.22 mL mark and verify with a nurse

Correct answer: 22 unit mark

On a U-100 insulin syringe, each unit mark corresponds to one unit of U-100 insulin, so 22 units aligns with the 22-unit mark.

Question 28: A thin, elderly resident requires an insulin injection. Which technique modification is most appropriate?

Inject into the thigh only for safety
Use a 45-degree angle or pinch the skin to avoid IM injection (Correct answer)
Use a longer needle to ensure adequate depth
Double the injection speed to reduce pain

Correct answer: Use a 45-degree angle or pinch the skin to avoid IM injection

In thin patients, using a 45-degree angle or creating a skin fold reduces the risk of inadvertent intramuscular injection.

Question 29: A blood glucose meter displays 'HI' instead of a number. This MOST likely means:

The test strip is expired
The resident is in a good mood
The battery is low
The blood glucose exceeds the meter's measurement range (usually >600 mg/dL) (Correct answer)

Correct answer: The blood glucose exceeds the meter's measurement range (usually >600 mg/dL)

'HI' on a glucometer indicates the blood glucose is above the meter's upper detection limit, signaling severe hyperglycemia requiring immediate nurse notification.

Question 30: Before administering a subcutaneous insulin injection, the QMA should clean the injection site with an alcohol swab and then:

Allow the alcohol to dry completely before injecting (Correct answer)
Wipe off the alcohol with a dry gauze before injecting
Blow on the site to speed drying
Inject immediately while the skin is still wet

Correct answer: Allow the alcohol to dry completely before injecting

Allowing alcohol to dry completely before injection prevents stinging and reduces the risk of introducing alcohol into the tissue.

Question 31: What PPE should a QMA wear when performing a fingerstick blood glucose test?

Gloves only (Correct answer)
Full gown and face shield
Gloves and mask
No PPE required for fingerstick

Correct answer: Gloves only

Standard precautions for fingerstick procedures require gloves to protect against bloodborne pathogen exposure.

Question 32: Which type of insulin is typically used for rapid control of blood sugar levels after meals?

Rapid-acting insulin (Correct answer)
Insulin glargine
Long-acting insulin
Intermediate-acting insulin

Correct answer: Rapid-acting insulin

Rapid-acting insulin is specifically designed to start working quickly, typically within 15-30 minutes, to lower blood sugar levels. It is commonly administered just before or immediately after meals to manage the rise in glucose that occurs after eating. This type of insulin provides immediate post-meal blood sugar control.

Question 33: After administering insulin, the QMA observes the resident becoming sweaty and confused. What is the priority action?

Notify the supervising nurse immediately and stay with the resident (Correct answer)
Offer the resident a snack and wait to see if symptoms resolve
Administer more insulin to stabilize the resident
Complete charting first, then notify the nurse

Correct answer: Notify the supervising nurse immediately and stay with the resident

Signs of hypoglycemia after insulin administration are an emergency requiring immediate nurse notification while staying with the resident for safety.

Question 34: A resident's blood glucose log shows readings consistently above 250 mg/dL over 3 days. What is the QMA's role?

Report the pattern to the nurse for clinical review (Correct answer)
Increase the insulin dose independently
Encourage more exercise without notifying the nurse
Switch to a different glucometer brand

Correct answer: Report the pattern to the nurse for clinical review

Persistent hyperglycemia is a clinical concern requiring nurse review; the QMA's role is to report patterns accurately, not to adjust treatment.

Question 35: Which condition would require the QMA to avoid a specific injection site?

Dry skin around the site
Scar tissue, bruising, or active infection at the site (Correct answer)
A mole more than 2 inches from the planned injection
Mild redness from a healed injection

Correct answer: Scar tissue, bruising, or active infection at the site

Sites with scar tissue, bruising, or infection must be avoided because they impair absorption and increase the risk of complications.

Question 36: A resident's blood glucose reads 'HI' (above meter range) before an insulin dose. The QMA should:

Hold the insulin and notify the nurse immediately (Correct answer)
Administer half the scheduled dose
Administer the full scheduled dose as ordered
Recheck in 15 minutes and then give the dose

Correct answer: Hold the insulin and notify the nurse immediately

An out-of-range 'HI' reading is an emergency finding that requires nurse notification before any insulin is given.

Question 37: Lipohypertrophy at injection sites is most commonly caused by:

Rotating injection sites too frequently
Injecting insulin that is too cold
Using too-thin needles
Repeatedly injecting into the same small area (Correct answer)

Correct answer: Repeatedly injecting into the same small area

Lipohypertrophy (fatty tissue buildup) results from injecting repeatedly into the same spot, which can cause erratic insulin absorption.

Question 38: A resident with poor circulation has cold, bluish fingertips. What is the best approach for blood glucose testing?

Use a larger lancet gauge
Test from the earlobe instead
Postpone testing until circulation improves
Warm the hand gently before testing (Correct answer)

Correct answer: Warm the hand gently before testing

Warming the hand with gentle friction or a warm cloth improves peripheral circulation and promotes adequate blood flow for the sample.

Question 39: When administering insulin via pen to an obese patient, the QMA should:

Use a longer pen needle to ensure subcutaneous delivery
Use a standard short needle at 90 degrees without pinching (Correct answer)
Double the dose to account for absorption variability
Always use a 45-degree angle regardless of tissue depth

Correct answer: Use a standard short needle at 90 degrees without pinching

In obese patients with ample subcutaneous fat, a short needle at 90 degrees without pinching safely reaches the subcutaneous layer.

Question 40: Basal insulin is intended to do which of the following?

Provide a continuous low-level of insulin coverage over 24 hours (Correct answer)
Correct high blood glucose emergencies immediately
Suppress appetite to reduce carbohydrate intake
Provide a rapid spike to cover mealtime glucose rises

Correct answer: Provide a continuous low-level of insulin coverage over 24 hours

Basal insulin provides a steady background level of insulin to control blood glucose between meals and overnight.

Question 41: Under HIPAA, a QMA may share a resident's insulin dosage information with:

The resident's neighbor who asks out of concern
A member of the care team directly involved in the resident's care (Correct answer)
Any staff member who works in the same facility
The press if there is public interest

Correct answer: A member of the care team directly involved in the resident's care

HIPAA permits sharing protected health information only with members of the care team who have a need to know for treatment purposes.

Question 42: Which situation requires the QMA to withhold insulin and contact the nurse before proceeding?

The resident states they already ate their meal
The resident confirms their identity correctly
The insulin pen is stored at the correct temperature
The resident's blood glucose falls below the threshold specified in the sliding scale order (Correct answer)

Correct answer: The resident's blood glucose falls below the threshold specified in the sliding scale order

A blood glucose below the specified threshold on a sliding scale is a clinical alert requiring nurse guidance before insulin is administered.

Question 43: A resident receives both a long-acting and a rapid-acting insulin. Which statement about administering these two insulins is correct?

Long-acting analogs (glargine, detemir) should NOT be mixed with other insulins (Correct answer)
Long-acting insulin should be given 30 minutes before the rapid-acting insulin
They can always be mixed in one syringe for convenience
Both should be injected into the same site simultaneously

Correct answer: Long-acting analogs (glargine, detemir) should NOT be mixed with other insulins

Long-acting insulin analogs like glargine and detemir must not be mixed with other insulins because it alters their pharmacokinetic profiles.

Question 44: A resident with Type 2 diabetes has lost significant weight and now requires insulin. What most likely explains this change?

Their beta cells have become exhausted over time (Correct answer)
Their diet has improved significantly
Weight loss always triggers insulin dependence
Their insulin resistance has resolved

Correct answer: Their beta cells have become exhausted over time

In Type 2 diabetes, beta cell function can decline progressively, eventually requiring insulin therapy.

Question 45: How should insulin be protected from direct sunlight?

Expose briefly to sunlight to warm it before injection
Store in an opaque container or a dark area away from windows (Correct answer)
Sunlight has no effect on insulin potency
Store in a clear container on a sunny windowsill

Correct answer: Store in an opaque container or a dark area away from windows

Ultraviolet light degrades insulin, so it must be kept away from direct sunlight and stored in opaque containers or dark locations.

Question 46: A resident on insulin is NPO (nothing by mouth) before a morning procedure. The QMA should:

Double the afternoon insulin dose to compensate
Skip all glucose checks while the resident is NPO
Give insulin as scheduled regardless of NPO status
Check blood glucose, withhold insulin, and notify the nurse for specific NPO insulin orders (Correct answer)

Correct answer: Check blood glucose, withhold insulin, and notify the nurse for specific NPO insulin orders

NPO status changes insulin requirements significantly; the QMA must check glucose, withhold the dose, and notify the nurse for specific orders.

Question 47: A QMA works at a facility where the RN has delegated the task of insulin administration for a specific resident. The resident reports feeling dizzy and shaky before their scheduled dose. What is the QMA's most appropriate action?

Tell the resident to lie down and re-evaluate them after 30 minutes.
Hold the insulin, check the resident's blood glucose, and immediately report the findings and symptoms to the nurse. (Correct answer)
Administer the insulin as ordered and document the resident's comments.
Give the resident a glass of orange juice and then administer the insulin.

Correct answer: Hold the insulin, check the resident's blood glucose, and immediately report the findings and symptoms to the nurse.

The resident's symptoms (dizziness, shakiness) are classic signs of hypoglycemia (low blood sugar). Administering insulin could be dangerous. The QMA's scope of practice requires them to report concerns or issues to the licensed nurse immediately and to not administer insulin if such concerns are present. Checking the blood glucose provides critical data for the nurse to assess the situation.

Question 48: How long should a QMA hold gentle pressure on the injection site after administering insulin?

Apply pressure for 5-10 seconds without rubbing (Correct answer)
No pressure is needed after subcutaneous injection
Rub vigorously for 30 seconds
Hold pressure for at least 2 minutes

Correct answer: Apply pressure for 5-10 seconds without rubbing

Gentle pressure for 5-10 seconds stops minor bleeding, while rubbing is avoided because it can accelerate insulin absorption unpredictably.

Question 49: When rotating injection sites within the abdomen, the QMA should space injections at least:

5 cm apart
10 cm apart
1 cm apart
2–3 cm (about 1 inch) apart (Correct answer)

Correct answer: 2–3 cm (about 1 inch) apart

Sites should be spaced at least 2–3 cm (approximately 1 inch) apart to prevent lipohypertrophy and ensure consistent absorption.

Question 50: Which site is generally NOT recommended for routine insulin injections?

Abdomen
Upper arm
Outer thigh
Calf (Correct answer)

Correct answer: Calf

The calf is not a recommended insulin injection site due to poor subcutaneous tissue and unpredictable absorption.

Question 51: A QMA accidentally administers insulin to the wrong resident. The first action after discovering the error is to:

Monitor the resident quietly and report at shift change
Administer glucose to prevent hypoglycemia proactively
Complete the incident report before notifying anyone
Assess the resident and notify the nurse immediately (Correct answer)

Correct answer: Assess the resident and notify the nurse immediately

Patient safety requires immediate clinical assessment and nurse notification so that monitoring and interventions can begin at once.

Question 52: A QMA's insulin administration certification has expired. What is the appropriate action?

Notify the resident that insulin will be temporarily delayed
Ask a coworker QMA to co-sign their administrations temporarily
Cease insulin administration immediately until recertification is completed (Correct answer)
Continue administering insulin until the renewal paperwork is processed

Correct answer: Cease insulin administration immediately until recertification is completed

An expired certification means the QMA no longer meets the legal requirement to administer insulin and must stop until recertification is complete.

Question 53: After administering insulin, a QMA observes that the resident has developed significant redness and swelling at the injection site. Which of the following best describes the QMA's responsibility for reporting and documentation?

Note the reaction on the MAR but only report it to the nurse if the resident complains of pain or itching.
Report the findings to the licensed nurse immediately and document the observation and the notification in the resident's record. (Correct answer)
Apply a cold pack to the site and document that the intervention was successful.
Document the observation in personal notes to discuss with the nurse at the end of the shift.

Correct answer: Report the findings to the licensed nurse immediately and document the observation and the notification in the resident's record.

Redness and swelling at an injection site are signs of a potential adverse reaction which requires immediate assessment by a licensed nurse. The QMA must report this observation to the nurse without delay. The QMA must also document their objective findings and the fact that they reported it to the nurse, including the time of notification and the nurse's name. [8]

Question 54: Which scenario represents a violation of a resident's right to dignity during insulin administration?

Explaining the procedure before administering
Offering a choice of injection site when clinically appropriate
Using a calm and respectful tone
Exposing the resident unnecessarily in front of others (Correct answer)

Correct answer: Exposing the resident unnecessarily in front of others

Unnecessarily exposing a resident violates their right to privacy and dignity, which must be maintained during all care.

Question 55: Which documentation error in the MAR creates the greatest insulin safety risk?

Failing to document a dose after it was given, potentially leading to a duplicate dose (Correct answer)
Documenting the injection site in the notes section instead of the MAR grid
Using black ink instead of blue ink as required by facility policy
Initialing in the wrong column when only one insulin is scheduled

Correct answer: Failing to document a dose after it was given, potentially leading to a duplicate dose

Undocumented doses create the risk of double-dosing when the next staff member believes the dose was not given.

Question 56: Which documentation element is essential immediately after administering an insulin injection?

The lot number of the alcohol swab
The QMA's personal opinion of the dose effectiveness
Time, dose, route, site, and patient response (Correct answer)
The brand name of the sharps container used

Correct answer: Time, dose, route, site, and patient response

Accurate documentation of time, dose, route, site, and patient response is legally required and ensures continuity of care.

Question 57: A sliding scale order states: 'Give 4 units for glucose 201-250, 6 units for 251-300.' A resident's glucose is 249 mg/dL. How many units are given?

5 units
3 units
4 units (Correct answer)
6 units

Correct answer: 4 units

249 mg/dL falls within the 201-250 range, so 4 units is the correct dose per the order.

Question 58: When a QMA suspects a resident may have received an insulin overdose due to a syringe calibration error, the FIRST step is:

Administer fast-acting carbohydrates to offset the extra insulin
Notify the nurse immediately and keep the resident under continuous observation (Correct answer)
Complete an incident report and then call the physician directly
Recheck the syringe markings and document the suspected error

Correct answer: Notify the nurse immediately and keep the resident under continuous observation

Potential overdose is a time-sensitive emergency — nursing must be alerted immediately so preventive glucose monitoring and treatment can begin.

Question 59: A resident received their dose of rapid-acting insulin 15 minutes ago and then ate breakfast. Shortly after eating, the resident vomits their entire meal. The QMA should be primarily concerned about the resident's risk for which acute complication?

Dehydration
Diabetic ketoacidosis
Hyperglycemia
Hypoglycemia (Correct answer)

Correct answer: Hypoglycemia

The rapid-acting insulin has already begun to work, lowering the resident's blood glucose. Because the resident vomited the meal that was intended to counteract the insulin, their blood sugar is likely to drop to dangerously low levels, creating a high risk for hypoglycemia.

Question 60: Which of the following is a reason to withhold a sliding scale insulin dose and contact the nurse BEFORE administering?

The resident has a known allergy to the prescribed insulin type (Correct answer)
The injection site shows normal skin integrity
Glucose is 185 mg/dL and the scale starts at 151 mg/dL
The resident ate breakfast 30 minutes ago

Correct answer: The resident has a known allergy to the prescribed insulin type

A known allergy to the prescribed insulin is a contraindication; the QMA must notify the nurse immediately before giving the medication.

QMA Insulin Qualified Medication Aide Exam

The QMA Insulin exam certifies Qualified Medication Aides in insulin administration, covering scope of practice, diabetes management, blood glucose monitoring, hypoglycemia/hyperglycemia response, and documentation.

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90 min

Time Limit

70%

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