QMA Insulin Qualified Medication Aide Exam — Questions and Answers

Question 1: Which statement about hypoglycemia unawareness is CORRECT?

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

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

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

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 3: A resident receiving basal-bolus insulin therapy develops nausea and vomiting after the bolus dose. Blood glucose is 280 mg/dL. The QMA should:

Hold all future insulin doses until the resident stops vomiting
Notify the nurse and monitor for signs of both hypoglycemia and DKA (Correct answer)
Administer the next basal dose on schedule and document the vomiting
Offer oral fluids and recheck glucose in 2 hours without notifying

Correct answer: Notify the nurse and monitor for signs of both hypoglycemia and DKA

Vomiting with elevated glucose in an insulin-dependent resident may signal developing DKA, requiring prompt nurse assessment.

Question 4: Which finger site is generally preferred for blood glucose testing in adults?

Lateral side of the fingertip (Correct answer)
Thumb
Pinky finger
Index finger tip center

Correct answer: Lateral side of the fingertip

The lateral (side) aspect of the fingertip is preferred because it has fewer nerve endings, causing less pain while still providing adequate blood flow.

Question 5: A resident with diabetes is found unconscious. The QMA confirms the resident has a pulse and is breathing. What should the QMA do FIRST?

Call for the nurse immediately and do not give anything by mouth (Correct answer)
Wait 15 minutes and reassess
Administer oral glucose gel between the cheek and gum
Inject insulin to correct a possible high blood sugar

Correct answer: Call for the nurse immediately and do not give anything by mouth

An unconscious resident is at risk for aspiration; nothing should be given by mouth, and emergency assistance must be called immediately.

Question 6: A resident reports tingling lips and sudden hunger 30 minutes after receiving insulin. Blood glucose is 62 mg/dL. The appropriate treatment is:

An additional insulin dose to stabilize levels
Withhold all food until the nurse arrives
A full meal immediately
15 grams of fast-acting carbohydrate such as 4 oz juice (Correct answer)

Correct answer: 15 grams of fast-acting carbohydrate such as 4 oz juice

The 15-15 rule calls for 15 g of fast-acting carbohydrate for mild hypoglycemia in a conscious, swallowing-capable resident.

Question 7: Documentation of a QMA's insulin training and competency validation should be kept in which location?

The resident's medical record
Posted publicly in the medication room
The QMA's personnel or training file at the facility (Correct answer)
Only in the QMA's personal records at home

Correct answer: The QMA's personnel or training file at the facility

Competency validation records are maintained in the QMA's personnel or training file at the employing facility for regulatory review.

Question 8: 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?

Administer the insulin as ordered and document the resident's comments.
Hold the insulin, check the resident's blood glucose, and immediately report the findings and symptoms to the nurse. (Correct answer)
Tell the resident to lie down and re-evaluate them after 30 minutes.
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 9: After administering a subcutaneous insulin injection, the QMA should NOT do which of the following?

Recap the needle using the one-hand scoop method before disposal (Correct answer)
Immediately dispose of the uncapped needle in an approved sharps container
Apply gentle pressure to the site with a cotton ball
Document the injection site and dose given

Correct answer: Recap the needle using the one-hand scoop method before disposal

Recapping needles is a leading cause of needlestick injuries; needles should be immediately disposed of uncapped in an approved sharps container.

Question 10: A resident is shaking, pale, and confused. The blood glucose reads 48 mg/dL. What should the QMA do first?

Give the scheduled insulin injection
Notify the nurse immediately (Correct answer)
Give the resident a glass of orange juice
Retest in 15 minutes

Correct 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.

Question 11: How should a QMA document a blood glucose value of 210 mg/dL obtained before breakfast?

Record only if above 250 mg/dL
Round to the nearest 50 mg/dL
Document the value, time, and that it was a fasting/pre-meal reading (Correct answer)
Wait until after insulin is given to document

Correct answer: Document the value, time, and that it was a fasting/pre-meal reading

Accurate documentation includes the exact reading, time, and context (pre-meal/fasting) to give the nurse complete clinical information.

Question 12: A state survey team audits a long-term care facility and requests QMA training records. The facility cannot produce competency documentation for one QMA who administers insulin. What is the likely consequence?

A deficiency citation and potential corrective action plan (Correct answer)
Automatic suspension of the entire facility's medication program
A warning letter to the QMA personally
No consequence if the QMA claims verbal training occurred

Correct answer: A deficiency citation and potential corrective action plan

Missing competency documentation typically results in a regulatory deficiency citation requiring the facility to submit a corrective action plan.

Question 13: Which of the following is an example of OBJECTIVE data that a QMA should document after insulin administration?

Blood glucose reading of 95 mg/dL at 0730 (Correct answer)
'The resident seemed nervous about the shot'
'I think the insulin is working well'
'The resident appeared to feel better afterward'

Correct answer: Blood glucose reading of 95 mg/dL at 0730

Objective data consists of measurable, observable facts such as a specific blood glucose value, not interpretations or feelings.

Question 14: Which type of insulin is NOT within QMA scope to administer without additional facility-specific authorization?

Intravenous insulin infusions (Correct answer)
Intermediate-acting insulin such as NPH
Rapid-acting insulin such as lispro
Long-acting basal insulin such as glargine

Correct answer: Intravenous insulin infusions

Intravenous insulin infusions require registered nurse administration and are outside QMA scope in virtually all states.

Question 15: Diabetic ketoacidosis (DKA) occurs most commonly in which type of diabetes?

Gestational diabetes
Steroid-induced diabetes
Type 2 diabetes
Type 1 diabetes (Correct answer)

Correct answer: Type 1 diabetes

DKA is most common in Type 1 diabetes because the complete absence of insulin forces the body to break down fat for fuel, producing ketones.

Question 16: Which blood glucose range is generally considered the target for most diabetic residents before meals?

80-130 mg/dL (Correct answer)
150-200 mg/dL
40-70 mg/dL
200-250 mg/dL

Correct answer: 80-130 mg/dL

The American Diabetes Association recommends a pre-meal blood glucose target of 80-130 mg/dL for most non-pregnant adults with diabetes.

Question 17: Which of the following best describes the QMA's role within the healthcare team for insulin management?

Supportive paraprofessional who administers insulin under licensed nurse supervision (Correct answer)
Independent clinician responsible for all insulin decisions
Replacement for the nurse when the nurse is on break
Equal partner with the nurse in prescribing insulin adjustments

Correct answer: Supportive paraprofessional who administers insulin under licensed nurse supervision

The QMA is a paraprofessional who administers medications under nurse supervision and does not make independent clinical decisions.

Question 18: A QMA is assisting a resident who uses a continuous glucose monitoring (CGM) device. Which statement accurately describes the QMA's role with this device?

The QMA can independently adjust insulin doses based on CGM trends.
The QMA can use the reader to obtain glucose readings as instructed by the nurse. (Correct answer)
The QMA is responsible for inserting and removing the CGM sensor.
The QMA should calibrate the CGM device daily using a fingerstick.

Correct answer: The QMA can use the reader to obtain glucose readings as instructed by the nurse.

According to the Indiana Department of Health QMA training module, a QMA can use the reader device to obtain glucose readings from a CGM but cannot apply, remove, or change the sensor. Any concerns must be reported to the licensed nurse. Adjusting insulin and calibrating the device are outside the QMA scope of practice.

Question 19: After completing a blood glucose test, how should a used lancet be disposed of?

Return to the medication cart for reuse
Place uncapped directly into a sharps container (Correct answer)
Wrap in a paper towel and discard
Recap and place in regular trash

Correct 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.

Question 20: After administering insulin, the QMA should apply gentle pressure to the injection site. This is done to:

Prevent the needle track from closing
Speed up insulin absorption into the bloodstream
Spread the insulin more evenly through the tissue
Prevent bruising and stop any minor bleeding (Correct answer)

Correct answer: Prevent bruising and stop any minor bleeding

Light pressure with a dry cotton ball or gauze helps stop minor bleeding or leakage without rubbing, which could alter absorption.

Question 21: Which of the following BEST describes the purpose of maintaining accurate insulin documentation?

To satisfy billing requirements only
To ensure resident safety, legal accountability, and continuity of care (Correct answer)
To reduce the workload of supervising nurses
To meet pharmacy inventory quotas

Correct answer: To ensure resident safety, legal accountability, and continuity of care

Accurate documentation protects resident safety, provides a legal record of care, and enables all team members to deliver consistent treatment.

Question 22: A QMA realizes after injection that the insulin pen was not primed and no insulin appeared at the needle tip during the prime check. This means:

The patient received a double dose due to pen malfunction
The dose was delivered correctly since the pen ejected insulin into the patient
The patient may have received less than the prescribed dose and the nurse must be notified (Correct answer)
The pen is defective and must be thrown away without further action

Correct answer: The patient may have received less than the prescribed dose and the nurse must be notified

Failure to prime may indicate air in the needle, meaning the patient could have received an inaccurate dose; the nurse must be notified immediately.

Question 23: A QMA suspects a coworker is diverting insulin. What should they do?

Report the suspicion to a supervisor or nurse immediately (Correct answer)
Ignore it unless they witness it themselves
Wait to confirm before taking any action
Confront the coworker directly

Correct answer: Report the suspicion to a supervisor or nurse immediately

Suspected diversion of medications must be reported immediately to a supervisor to protect residents and comply with legal obligations.

Question 24: How should an insulin vial be handled if it has been stored at room temperature for more than 28 days?

Return it to the refrigerator to extend its life
Discard the vial and obtain a new one (Correct answer)
Continue using it — the 28-day rule applies only to opened vials
Use it only for sliding scale, not scheduled doses

Correct answer: Discard the vial and obtain a new one

Most insulin vials stored at room temperature should be discarded after 28 days, as potency degrades beyond this point.

Question 25: Which of the following topics is generally not included in a QMA’s insulin administration certification training?

Determining insulin dosage based on blood sugar readings (Correct answer)
The different types of insulin and their effects
Recognizing signs of insulin overdose
Proper subcutaneous injection techniques

Correct answer: Determining insulin dosage based on blood sugar readings

While QMAs are trained to administer insulin, their scope of practice generally does not include determining insulin dosages. Dosage determination is a complex medical decision typically made by a licensed nurse or physician based on a patient's blood sugar readings, diet, and other medical factors. QMAs follow prescribed orders for insulin administration.

Question 26: A resident refuses to have their blood glucose checked before insulin administration. The QMA should:

Skip both the glucose check and the insulin dose without reporting
Physically restrain the resident to obtain the reading
Respect the refusal, document it, and notify the nurse (Correct answer)
Administer the insulin anyway using the last recorded value

Correct answer: Respect the refusal, document it, and notify the nurse

Residents have the right to refuse; the QMA must document the refusal and notify the nurse so a clinical decision can be made.

Question 27: When a QMA completes insulin training at one employer and transfers to a new employer in the same state, which step is typically required?

Repeat the full state training program from the beginning
No additional steps; the certification transfers automatically to any employer
Obtain a new state license before starting at the new employer
Provide proof of current certification and complete any facility-specific orientation or competency verification (Correct answer)

Correct answer: Provide proof of current certification and complete any facility-specific orientation or competency verification

While state certification may transfer, new employers typically require facility-specific orientation and may require a competency demonstration before the QMA administers insulin.

Question 28: 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
Recheck in 15 minutes and then give the dose
Administer the full scheduled dose as ordered

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 29: If a QMA notices a patient showing signs of hypoglycemia after administering insulin, what should be documented?

The patient's favorite food
The patient's blood sugar levels, signs of hypoglycemia, and any actions taken (Correct answer)
The time the patient fell asleep
The exact amount of insulin injected, even if it is correct

Correct answer: The patient's blood sugar levels, signs of hypoglycemia, and any actions taken

When a patient shows signs of hypoglycemia after insulin administration, thorough documentation is critical for patient safety and effective management. Recording the patient's blood sugar levels confirms the hypoglycemic event, while noting specific signs helps identify the severity. Documenting actions taken, such as administering glucose, ensures the care team is aware of the intervention and can follow up appropriately.

Question 30: When a QMA suspects a resident may have received an insulin overdose due to a syringe calibration error, the FIRST step is:

Recheck the syringe markings and document the suspected error
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

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 31: Immediately after administering an insulin injection, the QMA accidentally sticks themselves with the used needle. Which of the following is the most critical first step the QMA should take?

Cover the site with a bandage and continue with medication rounds.
Immediately wash the affected area with soap and water. (Correct answer)
Squeeze the puncture site to encourage bleeding.
Report the incident to the supervisor at the end of the shift.

Correct answer: Immediately wash the affected area with soap and water.

The immediate priority after a needlestick injury is to clean the wound to reduce the risk of bloodborne pathogen transmission. The CDC recommends washing the area thoroughly with soap and water. Reporting the incident is also critical but comes after initial first aid.

Question 32: A resident's sliding scale order has not been renewed and expired at midnight. It is now 7 AM and the resident's glucose is 280 mg/dL. What should the QMA do?

Hold insulin and notify the nurse to obtain a new order (Correct answer)
Administer the last documented dose
Use the previous scale until the nurse responds
Contact the pharmacy directly for a renewal

Correct answer: Hold insulin and notify the nurse to obtain a new order

Expired orders are invalid; the QMA must hold the medication and notify the nurse so a new physician order can be obtained.

Question 33: While caring for a resident, a QMA observes they are confused, anxious, sweating, and have a rapid heart rate. The resident is awake and able to swallow. What is the QMA's most appropriate initial action?

Offer the resident a glass of water and help them lie down.
Wait 30 minutes to see if the symptoms resolve on their own.
Administer the resident's scheduled long-acting insulin immediately.
Check the resident's blood glucose level. (Correct answer)

Correct answer: Check the resident's blood glucose level.

The resident is displaying classic signs and symptoms of hypoglycemia (low blood sugar). The first and most critical step is to confirm this by checking their blood glucose level before taking further action, such as providing a fast-acting carbohydrate, and notifying the nurse.

Question 34: A QMA is preparing to administer NPH insulin to a resident. What is the most critical time period to monitor this resident for signs of hypoglycemia?

Only at the next scheduled mealtime.
10 to 12 hours after injection.
4 to 12 hours after injection. (Correct answer)
Within the first 30 minutes after injection.

Correct answer: 4 to 12 hours after injection.

NPH is an intermediate-acting insulin. Its peak time, when it is most effective and the risk of hypoglycemia is highest, is between 4 and 12 hours after administration.

Question 35: Which scenario represents an appropriate emergency disclosure to the nurse regarding insulin safety?

A resident's blood glucose is 55 mg/dL and the resident is drowsy after eating the full meal (Correct answer)
A resident declines a routine blood glucose check once
A resident asks a question about their diabetes medication
An insulin pen has 10 units remaining and the scheduled dose is 8 units

Correct answer: A resident's blood glucose is 55 mg/dL and the resident is drowsy after eating the full meal

Blood glucose of 55 with drowsiness after eating suggests hypoglycemia is not resolving with food — a dangerous clinical situation needing nurse assessment.

Question 36: A resident's blood glucose log must be kept for how long according to most state long-term care regulations?

30 days
Only until the next physician visit
1 week
At least as long as required by the facility's medical records retention policy (often years) (Correct answer)

Correct answer: At least as long as required by the facility's medical records retention policy (often years)

Medical records, including glucose logs, must be retained per state and federal regulations, typically for several years after care ends.

Question 37: A resident refuses their scheduled insulin injection. The QMA's first response should be to:

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

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 38: A QMA is asked to sign the MAR for insulin that a nurse administered. The QMA should:

Sign it only if they were present in the room
Sign it as a courtesy to the nurse
Ask the nurse to initial next to the QMA's signature
Refuse, because signing for medication you did not administer is falsification (Correct answer)

Correct answer: Refuse, because signing for medication you did not administer is falsification

Signing the MAR for a medication administered by someone else is falsification of medical records, which is illegal and professionally prohibited.

Question 39: The legal concept that protects a QMA who reports suspected elder abuse in good faith is called:

Implied consent
Standard of care
Mandatory reporting immunity (Correct answer)
Respondeat superior

Correct answer: Mandatory reporting immunity

Most states provide legal immunity to mandatory reporters who report suspected abuse in good faith, protecting them from civil liability.

Question 40: A QMA discovers a discrepancy between the insulin remaining in the pen and the units documented on the MAR. What is the correct action?

Ignore it if the difference is small
Adjust the documentation to match the pen remaining
Discard the pen and open a new one without reporting
Report the discrepancy to the charge nurse and document the report (Correct answer)

Correct answer: Report the discrepancy to the charge nurse and document the report

Discrepancies between insulin supply and MAR records must be reported to the charge nurse immediately and documented, as this may indicate a medication diversion or error.

Question 41: A resident with type 2 diabetes skipped lunch but still received their usual insulin dose. The QMA should monitor this resident closely for signs of:

Hypernatremia
Ketoacidosis
Hypoglycemia (Correct answer)
Hyperglycemia

Correct answer: Hypoglycemia

Skipping a meal after receiving insulin removes the carbohydrate needed to balance the insulin, greatly increasing the risk of hypoglycemia.

Question 42: When a resident's blood glucose is within the normal range and insulin is administered per the sliding scale, the QMA's documentation should include:

Just a checkmark in the MAR without additional detail
Only the insulin dose given
Glucose value, time checked, insulin type/dose/site/time administered, and resident response (Correct answer)
The resident's weight and temperature

Correct answer: Glucose value, time checked, insulin type/dose/site/time administered, and resident response

Complete insulin documentation requires the glucose reading, when it was taken, and full details of insulin administration including type, dose, site, and time.

Question 43: Which of the following is a QMA permitted to do if a resident's insulin pen appears to be malfunctioning?

Use a different pen from another resident's medication supply
Withhold the dose and notify the nurse immediately (Correct answer)
Attempt to repair the pen mechanism themselves
Administer the dose from a vial using a syringe without an order

Correct answer: Withhold the dose and notify the nurse immediately

A malfunctioning device is a safety concern requiring nurse notification; the QMA should not attempt repairs or improvise with unauthorized supplies.

Question 44: What ethical consideration is involved when administering insulin to a patient?

Administering insulin based on your own professional judgment
Withholding insulin if the patient refuses to take it without providing any explanation
Deciding the patient’s insulin dosage based on their needs
Ensuring the patient understands the procedure and gives informed consent (Correct answer)

Correct answer: Ensuring the patient understands the procedure and gives informed consent

A key ethical consideration in healthcare is respecting patient autonomy, which includes the right to informed consent. Before administering insulin, a QMA should ensure the patient understands what medication they are receiving, why it's necessary, and any potential side effects. This allows the patient to make an informed decision and give consent, upholding their right to participate in their own care.

Question 45: Which report must a QMA complete if a resident receives insulin intended for a different resident?

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

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 46: Under state QMA regulations, insulin administration by a QMA typically requires completion of which prerequisite?

A physician-supervised internship of at least one year
A written exam administered by the resident's physician
A registered nurse license in addition to QMA certification
A state-approved insulin administration training program (Correct answer)

Correct answer: A state-approved insulin administration training program

Most states require QMAs to complete a specific, state-approved insulin administration training course before they may administer insulin.

Question 47: 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)
Double the injection speed to reduce pain
Use a longer needle to ensure adequate depth

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 48: A resident refused breakfast but a sliding scale insulin dose was already drawn up. What should the QMA do?

Administer the insulin anyway to prevent hyperglycemia
Give half the dose and document the refusal
Store the drawn dose in the refrigerator for later
Discard the drawn dose and notify the nurse (Correct answer)

Correct answer: Discard the drawn dose and notify the nurse

A pre-drawn dose that cannot be administered must be discarded per facility policy, and the nurse must be notified about the meal refusal.

Question 49: What does 'U-100' printed on an insulin vial label indicate?

The insulin requires a 100-gauge needle
The insulin expires in 100 days
There are 100 units of insulin per milliliter (Correct answer)
The vial contains 100 total milliliters

Correct answer: There are 100 units of insulin per milliliter

U-100 means the insulin concentration is 100 units per milliliter, which is the standard concentration used in the United States.

Question 50: A resident who uses an insulin pen leaves the needle attached after injection. The QMA should explain that this can cause:

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

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 51: A QMA notices a resident's prescribed insulin is a new brand unfamiliar to them. What is the appropriate action?

Refuse to administer it permanently
Administer it since it is prescribed and assume it works the same
Consult the supervising nurse and review medication information before administering (Correct answer)
Ask the resident to explain the medication

Correct answer: Consult the supervising nurse and review medication information before administering

When unfamiliar with a medication, the QMA should consult the nurse and review available drug information to ensure safe administration.

Question 52: A QMA witnesses another employee physically forcing a resident to accept an insulin injection. This is legally considered:

Only reportable if the resident is injured
Assault and battery, which must be reported immediately (Correct answer)
A gray area that depends on the nurse's order
Acceptable if the resident has dementia

Correct answer: Assault and battery, which must be reported immediately

Forcing treatment on a resident constitutes assault and battery and must be reported to the supervisor and appropriate authorities immediately.

Question 53: A QMA is about to inject insulin into a patient's upper arm. What angle is typically recommended for a standard insulin pen needle?

60 degrees
45 degrees
30 degrees
90 degrees (Correct answer)

Correct answer: 90 degrees

Modern short pen needles (4–6 mm) are generally inserted at a 90-degree angle to ensure delivery into subcutaneous tissue.

Question 54: At what angle is a subcutaneous insulin injection typically administered to a thin or average adult?

45 degrees
Either 45 or 90 degrees depending on tissue depth (Correct answer)
90 degrees
15 degrees

Correct answer: Either 45 or 90 degrees depending on tissue depth

Injection angle depends on the amount of subcutaneous tissue; 90° is used with adequate tissue and short needles, 45° for thinner individuals.

Question 55: A QMA administers insulin to the wrong resident due to a room mix-up. What is the first priority after discovering the error?

Wait to see if the wrong resident shows adverse effects before reporting
Administer the correct resident's insulin immediately without reporting
Notify the supervising nurse immediately and complete an incident report (Correct answer)
Document the error in personal notes only

Correct answer: Notify the supervising nurse immediately and complete an incident report

A medication error must be reported to the nurse immediately so appropriate clinical intervention can occur and an incident report completed.

Question 56: When documenting insulin administration, which blood glucose value would require the QMA to withhold the dose AND document a parameter hold?

145 mg/dL
180 mg/dL
58 mg/dL (Correct answer)
110 mg/dL

Correct 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.

Question 57: A QMA is preparing insulin and draws up more than the prescribed dose by mistake before administering. What is the correct response?

Document nothing if the error is corrected before administration
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)
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 58: Which documentation must be completed IMMEDIATELY after administering sliding scale insulin?

Blood glucose value, dose given, site used, time, and initials (Correct answer)
A nursing progress note only
The resident's weight and vital signs
Only the blood glucose reading

Correct answer: Blood glucose value, dose given, site used, time, and initials

Complete documentation requires the blood glucose reading, insulin dose, injection site, time of administration, and the QMA's initials.

Question 59: Which of the following is the correct technique for administering a subcutaneous insulin injection?

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

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 60: A resident's blood glucose is 210 mg/dL. The sliding scale orders: 151-200 = 2 units, 201-250 = 4 units, 251-300 = 6 units. How many units should be given?

2 units
6 units
0 units
4 units (Correct answer)

Correct answer: 4 units

210 mg/dL falls in the 201-250 range, so 4 units of insulin is the correct dose.

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.

Questions

90 min

Time Limit

70%

To Pass

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