Mixed Deck — All QMA INSULIN Topics Flashcards

A resident is shaking, pale, and confused. The blood glucose reads 48 mg/dL. What should the QMA do first?

Answer: Notify the nurse immediately

The QMA must notify the nurse immediately; treatment decisions for hypoglycemia are outside the QMA's scope without a nurse directive.

Which of the following demonstrates culturally competent communication during insulin administration for a QMA?

Answer: Acknowledge and respect the resident's cultural or religious beliefs while ensuring safe medication administration and involving the nurse if conflicts arise

Culturally competent care involves recognizing individual beliefs and practices, respectfully addressing them, and collaborating with the nurse to accommodate cultural needs within safe care parameters.

Which action violates a resident's right to self-determination?

Answer: Forcing insulin administration against the resident's expressed refusal

Forcing treatment on a competent resident who has refused it violates the legal and ethical right to self-determination and may constitute assault.

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

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.

Which communication technique is most effective when explaining insulin administration to an elderly resident with hearing loss?

Answer: Face the resident directly, speak clearly at a moderate pace, and use simple language; written materials may also help

Clear, direct communication with a visible face for lip-reading, moderate pacing, and simple language — supplemented by written materials if needed — is most effective for hearing-impaired residents.

When documenting insulin administration, which blood glucose value would require the QMA to withhold the dose AND document a parameter hold?

Answer: 58 mg/dL

A blood glucose of 58 mg/dL is below typical hold parameters (usually <70 mg/dL), requiring the dose to be withheld and documented accordingly.

The abbreviation 'subQ' on a medication order means the insulin should be administered:

Answer: Into the fatty tissue just beneath the skin

SubQ (subcutaneous) refers to the layer of adipose tissue beneath the dermis, which is the correct route for insulin.

A resident's blood glucose is 140 mg/dL. The sliding scale order states to give 0 units for blood glucose <150 mg/dL. The resident is also scheduled for a routine dose of 10 units of long-acting insulin. What should the QMA do?

Answer: Administer the 10 units of long-acting insulin only.

Sliding scale insulin is typically a supplemental, or 'correction', dose of rapid- or short-acting insulin added to a resident's routine insulin regimen. In this case, the blood sugar is below the threshold for a correction dose, so no sliding scale insulin is given. However, the standing order for the long-acting (basal) insulin should still be administered as prescribed unless there are specific orders to hold it.

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

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.

How long should the needle remain inserted after injecting insulin when using a standard insulin syringe?

Answer: Hold for 5–10 seconds

Holding the needle in place for 5–10 seconds after injection helps ensure all insulin is delivered and reduces leakage.

An insulin pen is primed by dialing 2 units and pressing the plunger until a drop of insulin appears. Why is priming important?

Answer: It removes air from the needle and confirms the pen is working

Priming expels any air in the needle and confirms the pen and new needle are functioning, ensuring accurate dose delivery.

When a resident refuses insulin administration, what is the first action a QMA should take?

Answer: Inform the supervising nurse immediately and document the refusal

A competent resident has the right to refuse medication; the QMA must immediately notify the supervising nurse and document the refusal per facility policy.

After administering sliding scale insulin, when should the QMA expect to recheck blood glucose for a resident given rapid-acting insulin?

Answer: In 1-2 hours, or per facility/physician order

Rapid-acting insulin peaks in about 1-2 hours; a glucose recheck at this interval (or per order) confirms the correction was effective.

A QMA checks a resident's blood glucose, and the result is 375 mg/dL. The sliding scale order is as follows: - 251-300 mg/dL: 6 units - 301-350 mg/dL: 8 units - Above 350 mg/dL: Call MD/RN What is the QMA's correct action?

Answer: Hold the insulin and notify the supervising nurse.

The physician's order explicitly directs the QMA to call the MD or RN for a blood glucose reading above 350 mg/dL. The QMA's scope of practice requires them to follow the order precisely and not to administer a dose that is not specified or to make an independent clinical judgment.

When performing a subcutaneous insulin injection, the QMA should release the skin fold:

Answer: After withdrawing the needle

The skin fold should be released after needle withdrawal to prevent the needle from being redirected into muscle during injection.

Which insulin storage rule applies specifically to insulin glargine (Lantus)?

Answer: Do not mix it with any other insulin in the same syringe

Insulin glargine must never be mixed with other insulins because mixing alters its pH and changes its pharmacokinetic profile, making it unpredictable.

A QMA witnesses another QMA skip documentation after giving insulin. What is the appropriate response?

Answer: Encourage the colleague to complete their own documentation and report if they refuse

A QMA should encourage the colleague to complete their own documentation; if refused, the issue must be escalated to the nurse because altering or completing another's record is improper.

A QMA is caring for a resident who has an infection and a fever. The QMA should be aware that this resident is at an increased risk for developing which condition?

Answer: Hyperglycemia, because illness and stress can raise blood sugar.

Illness, infection, and other forms of physical or emotional stress can cause the body to release hormones that raise blood glucose levels, leading to hyperglycemia. This is a crucial factor for a QMA to monitor in a diabetic resident who becomes ill.

After completing a blood glucose test, how should a used lancet be disposed of?

Answer: Place uncapped directly into a sharps container

Used lancets are sharps and must be placed uncapped directly into an approved sharps container to prevent needlestick injuries.

A QMA is reviewing a new sliding scale insulin order. The order contains the following ranges: 150-200 mg/dL and 200-250 mg/dL. What is the most appropriate action for the QMA to take?

Answer: Notify the delegating RN of the overlapping blood sugar ranges in the order.

Sliding scale orders must have clear, non-overlapping ranges to prevent medication errors. An order with overlapping values (e.g., where 200 mg/dL appears in two different ranges) is ambiguous and unsafe. The QMA must report this to the RN for clarification from the prescriber.