QMA Insulin Qualified Medication Aide Exam — Questions and Answers

Question 1: What ethical consideration is involved when administering insulin to a patient?

Deciding the patient’s insulin dosage based on their needs
Withholding insulin if the patient refuses to take it without providing any explanation
Administering insulin based on your own professional judgment
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 2: A resident with type 1 diabetes who takes insulin develops sudden severe headache and slurred speech. The QMA should FIRST:

Check blood glucose and treat for hypoglycemia
Offer juice and wait 15 minutes to reassess
Call 911 and notify the nurse simultaneously (Correct answer)
Document the symptoms and monitor for 30 minutes

Correct answer: Call 911 and notify the nurse simultaneously

Severe headache and slurred speech may indicate a stroke or severe hypoglycemia requiring emergency services, not just a glucose check.

Question 3: A QMA is asked by a family member to administer an extra insulin dose because the resident 'seems high.' What should the QMA do?

Administer the extra dose since a family member requested it
Ask the resident if they want the extra dose
Check blood glucose and administer extra insulin based on the result
Decline and notify the nurse, who can assess and determine next steps (Correct answer)

Correct answer: Decline and notify the nurse, who can assess and determine next steps

Family members cannot authorize medication administration; the QMA must decline and notify the nurse for appropriate clinical evaluation.

Question 4: A QMA is preparing to give a subcutaneous insulin injection. At what angle should the needle be inserted for a patient with adequate subcutaneous tissue?

45 degrees
15 degrees
10 degrees
90 degrees (Correct answer)

Correct answer: 90 degrees

A 90-degree angle is used for patients with adequate subcutaneous tissue to ensure proper subcutaneous delivery.

Question 5: What is the QMA's responsibility if they believe a nurse's insulin order contains a potential error?

Refuse to give any medications that day
Correct the order in the MAR themselves
Administer the dose since the nurse is licensed and responsible
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 6: Which hormone is released by the pancreas to LOWER blood glucose levels?

Glucagon
Insulin (Correct answer)
Epinephrine
Cortisol

Correct answer: Insulin

Insulin, released by beta cells in the pancreas, facilitates cellular glucose uptake and lowers blood glucose levels.

Question 7: A QMA with an insulin certification is preparing to administer insulin to a resident. The resident's blood glucose level is within the range specified on the sliding scale order. What is the immediate next step for the QMA?

Recalculate the dose based on the resident's meal intake.
Administer half the dose and recheck the blood glucose in 15 minutes.
Administer the insulin dose as indicated on the sliding scale. (Correct answer)
Contact the licensed nurse to get permission to administer the dose.

Correct answer: Administer the insulin dose as indicated on the sliding scale.

According to the QMA scope of practice for insulin administration, if the physician's order includes a sliding scale and the resident's blood glucose level falls within a specific range on that scale, the QMA is authorized to administer the exact amount of insulin ordered for that range. No additional authorization from the nurse is required for each administration as long as it follows the physician's specific order.

Question 8: When preparing a subcutaneous insulin injection, which needle angle is most commonly recommended?

45- to 90-degree angle depending on body habitus (Correct answer)
Straight 90-degree angle only, regardless of body fat
15-degree angle
Less than 15-degree angle for shallow injection

Correct answer: 45- to 90-degree angle depending on body habitus

A 45-degree angle is used for thin individuals with less subcutaneous fat, while a 90-degree angle is used for those with adequate subcutaneous tissue.

Question 9: When teaching a patient about insulin injection technique, the QMA should instruct them to inject into:

The dermis for controlled release
Subcutaneous tissue just below the skin (Correct answer)
A vein for immediate effect
Muscle tissue for faster action

Correct answer: Subcutaneous tissue just below the skin

Subcutaneous tissue provides the correct absorption rate for insulin; intramuscular injection causes faster, less predictable absorption.

Question 10: Glucagon, produced by alpha cells of the pancreas, has which effect on blood glucose?

Raises blood glucose by stimulating glycogen breakdown (Correct answer)
Prevents glucose from entering the bloodstream
Has no effect on blood glucose levels
Lowers blood glucose by storing it as fat

Correct answer: Raises blood glucose by stimulating glycogen breakdown

Glucagon signals the liver to break down glycogen and release glucose into the blood, raising blood sugar levels.

Question 11: Which statement accurately describes QMA liability related to insulin administration?

Liability rests solely with the facility, not individual QMAs
The QMA is personally accountable for insulin administration actions within their scope (Correct answer)
QMAs cannot be held liable because they work under delegation
The supervising nurse bears all liability; the QMA has none

Correct answer: The QMA is personally accountable for insulin administration actions within their scope

QMAs retain personal accountability for their own actions during insulin administration, even when working under nurse delegation.

Question 12: The legal concept that protects a QMA who reports suspected elder abuse in good faith is called:

Standard of care
Implied consent
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 13: Which of the following is typically part of a QMA’s training when learning to administer insulin?

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

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 14: What should a QMA do if insulin appears cloudy, discolored, or has visible particles (for a type that should be clear)?

Use the insulin but document the appearance
Shake the vial vigorously to dissolve particles
Discard the insulin and obtain a new vial (Correct answer)
Warm the vial under hot water

Correct answer: Discard the insulin and obtain a new vial

Insulin that appears abnormal — cloudy, discolored, or with particles when it should be clear — must be discarded as it may be contaminated or degraded.

Question 15: When using an insulin vial, what is the correct technique for withdrawing insulin to avoid contamination?

Insert the needle without cleaning the stopper to prevent residue
Wipe the stopper with a dry cotton ball
Use the same needle for multiple withdrawals from the same vial
Clean the rubber stopper with an alcohol swab before each withdrawal (Correct answer)

Correct answer: Clean the rubber stopper with an alcohol swab before each withdrawal

The rubber stopper of the insulin vial must be cleaned with a fresh alcohol swab before each needle insertion to prevent microbial contamination.

Question 16: Which of the following tasks is explicitly outside the scope of practice for a QMA who has completed the insulin administration module?

Documenting the insulin dose administered in the resident's chart.
Administering a pre-filled syringe of Trulicity. (Correct answer)
Performing a finger stick blood glucose test.
Administering a dose of U-100 Lantus via an insulin pen.

Correct answer: Administering a pre-filled syringe of Trulicity.

The QMA insulin certification is strictly for administering insulin. QMAs are explicitly not allowed to administer other injectable, non-insulin medications used to treat diabetes, such as Trulicity or Ozempic. Performing blood glucose tests, administering standard insulin, and documenting are all within the QMA's scope.

Question 17: Which of the following is a key characteristic of long-acting insulin?

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

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 18: If a QMA's insulin administration certification lapses due to failure to renew, the correct action is to:

Immediately stop administering insulin and complete renewal requirements before resuming (Correct answer)
Notify the resident's family and continue without certification
Continue administering insulin until the next scheduled renewal date
Ask another QMA to sign off on administered doses retroactively

Correct answer: Immediately stop administering insulin and complete renewal requirements before resuming

A lapsed certification means the QMA is no longer authorized to administer insulin; they must immediately stop and complete renewal before resuming.

Question 19: The 'rule of 15' for treating mild hypoglycemia recommends which action?

Give 15 mL of juice every 15 seconds until symptoms resolve
Give 15 grams of fast-acting carbs and recheck blood sugar in 15 minutes (Correct answer)
Wait 15 minutes before any intervention
Give 15 units of insulin and recheck in 15 minutes

Correct answer: Give 15 grams of fast-acting carbs and recheck blood sugar in 15 minutes

The rule of 15 involves giving 15 grams of fast-acting carbohydrate and rechecking blood glucose after 15 minutes to guide further treatment.

Question 20: Which statement best describes the QMA's role in educating residents about their insulin therapy?

Discourage residents from asking questions about their medication
Provide basic reinforcement of information already given by the nurse or physician, within the QMA's scope (Correct answer)
Independently design a full diabetes education program for the resident
Advise residents to change their insulin doses based on symptoms

Correct answer: Provide basic reinforcement of information already given by the nurse or physician, within the QMA's scope

QMAs may reinforce basic education provided by licensed staff but must not independently counsel residents on complex medical decisions or dose adjustments.

Question 21: Which of the following best describes the QMA's role within the healthcare team for insulin management?

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

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 22: Which of the following statements about lancet reuse is correct for long-term care settings?

Lancets can be shared between residents if cleaned with alcohol
Lancets may be reused up to three times on the same resident
Reuse is acceptable only if the lancet appears undamaged
Lancets are single-use only and must not be reused (Correct answer)

Correct answer: Lancets are single-use only and must not be reused

Lancets are single-use medical devices; reuse dulls the tip, increases infection risk, and violates standard infection control practices.

Question 23: How far from the navel should insulin injections be avoided?

0.5 inch (1.3 cm)
2 inches (5 cm) (Correct answer)
1 inch (2.5 cm)
3 inches (7.6 cm)

Correct answer: 2 inches (5 cm)

Injections should be avoided within 2 inches of the navel because the tissue there is denser and absorption is unpredictable.

Question 24: What should a QMA do if they administer an incorrect dose of insulin?

Wait until the next shift to report the error
Correct the dose by administering the right amount of insulin
Immediately report the error to the supervising nurse or physician (Correct answer)
Document the incident, but do nothing else

Correct answer: Immediately report the error to the supervising nurse or physician

Administering an incorrect dose of insulin is a serious medication error that can have immediate and severe consequences for the patient. The QMA's primary responsibility is patient safety, which requires immediate reporting to a supervising nurse or physician. This allows for prompt assessment of the patient's condition, implementation of corrective measures, and prevention of further harm.

Question 25: A thin, elderly resident requires an insulin injection. Which technique modification is most appropriate?

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

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 26: After withdrawing the needle following an insulin injection, the QMA should apply light pressure to the site with a dry cotton ball or gauze. The reason for NOT rubbing the site is:

Rubbing is only avoided for IV sites, not subQ
Rubbing can spread bacteria from surrounding skin
Rubbing can accelerate insulin absorption unpredictably (Correct answer)
Rubbing may cause the needle track to reopen

Correct answer: Rubbing can accelerate insulin absorption unpredictably

Rubbing the injection site can increase absorption speed unpredictably, potentially altering the insulin's expected onset and duration.

Question 27: Under what circumstances must a QMA with insulin certification NOT administer insulin, even if there is a physician's order?

The resident expresses a fear of needles.
The supervising RN is on a scheduled lunch break within the facility.
The facility's policy on insulin administration by a QMA is not available for review. (Correct answer)
The blood glucose reading is at the higher end of the prescribed range.

Correct answer: The facility's policy on insulin administration by a QMA is not available for review.

It is the responsibility of the QMA to understand and review the facility's policies and procedures related to insulin administration. If the facility does not have these policies available, the QMA must not administer insulin. This is a critical safety measure to ensure the QMA is acting within the facility's established guidelines which are based on state regulations.

Question 28: Which of the following elements is ESSENTIAL for a QMA to document on the Medication Administration Record (MAR) immediately after administering an insulin injection?

The specific anatomical site used for the injection. (Correct answer)
The brand of the glucometer used for the test.
The time the next dose of insulin is scheduled to be given.
The resident's food choice for their recent meal.

Correct answer: The specific anatomical site used for the injection.

Proper documentation after insulin administration must include the date, time, dose given, the resident's blood sugar level, and the specific site of injection (e.g., right abdomen, left upper arm). [14, 15] Recording the site is vital for ensuring proper site rotation, preventing skin complications like lipohypertrophy, and providing a complete record for continuity of care. [13]

Question 29: Which of the following would indicate improper subcutaneous insulin technique resulting in intramuscular injection?

No change in glucose levels at all
Slightly slower than expected blood glucose lowering
Insulin leaking back out at the injection site
Faster and more intense glucose-lowering effect with greater variability (Correct answer)

Correct answer: Faster and more intense glucose-lowering effect with greater variability

Intramuscular injection causes faster and more unpredictable insulin absorption due to greater blood supply in muscle tissue.

Question 30: A QMA draws up insulin and then is interrupted before giving it. What should the QMA do regarding documentation?

Leave the syringe for the next QMA to administer
Document the dose as given since it was prepared
Administer immediately regardless of the interruption cause
Discard the drawn insulin, document the discard, and start over when able (Correct answer)

Correct answer: Discard the drawn insulin, document the discard, and start over when able

Drawn insulin that cannot be administered promptly must be discarded and the discard documented; it should never be left unattended or given by another staff member.

Question 31: A resident with diabetes reports numbness and tingling in their feet. This is most consistent with which complication?

Diabetic retinopathy
Diabetic cardiomyopathy
Diabetic neuropathy (Correct answer)
Diabetic nephropathy

Correct answer: Diabetic neuropathy

Peripheral diabetic neuropathy commonly presents as numbness, tingling, or burning sensations in the feet and lower extremities.

Question 32: Which of the following best describes the primary physiological difference between Type 1 and Type 2 diabetes?

In Type 1, the body produces no insulin, while in Type 2, the body's cells do not use insulin effectively. (Correct answer)
Type 1 always develops in adulthood, whereas Type 2 is diagnosed in childhood.
Type 1 is caused by lifestyle factors, while Type 2 is purely genetic.
Individuals with Type 2 diabetes never require insulin, unlike those with Type 1.

Correct answer: In Type 1, the body produces no insulin, while in Type 2, the body's cells do not use insulin effectively.

Type 1 diabetes is an autoimmune condition where the pancreas produces little to no insulin. In Type 2 diabetes, the body either resists the effects of insulin or doesn't produce enough to maintain normal glucose levels; this is known as insulin resistance.

Question 33: Which statement about electronic MARs (eMARs) is TRUE for QMAs?

eMARs do not require the injection site to be recorded
Each entry is time-stamped and linked to the QMA's login, creating a permanent record (Correct answer)
Another staff member may document under the QMA's login if needed
Corrections can be deleted without any audit trail

Correct answer: Each entry is time-stamped and linked to the QMA's login, creating a permanent record

eMARs automatically time-stamp each entry and associate it with the logged-in user, creating an unalterable audit trail.

Question 34: Which action by a QMA constitutes medication fraud?

Asking a colleague to witness a refusal
Documenting insulin given after a brief delay
Recording insulin as administered when it was not given (Correct answer)
Notifying the nurse of a missed dose

Correct answer: Recording insulin as administered when it was not given

Charting a medication as given when it was not administered is falsification of medical records and constitutes fraud.

Question 35: Which needle gauge is most commonly used for subcutaneous insulin injections?

28–31 gauge (Correct answer)
21–23 gauge
18–20 gauge
34–36 gauge

Correct answer: 28–31 gauge

Insulin syringes and pen needles typically use 28–31 gauge needles, which are fine enough to minimize pain and trauma.

Question 36: Lipohypertrophy at injection sites is most commonly caused by:

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

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

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

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

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

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

Convince the resident to accept the insulin by explaining consequences
Inform the supervising nurse immediately and document the refusal (Correct answer)
Skip the dose and document nothing until the next scheduled dose
Administer the insulin anyway to ensure the resident's health

Correct 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.

Question 40: Which statement best describes the scope of insulin administration authority granted to a QMA?

QMAs may administer any insulin product in any dose at their discretion
QMAs have unlimited insulin administration authority once certified
QMAs may administer insulin but cannot document the administration
QMAs administer insulin only as specifically delegated and documented by a licensed nurse or provider (Correct answer)

Correct answer: QMAs administer insulin only as specifically delegated and documented by a licensed nurse or provider

QMA insulin administration authority is limited to delegated tasks with documentation, as authorized by a licensed nurse or provider within the care plan.

Question 41: A QMA must report a change in a resident's condition after insulin administration. To which person should this FIRST be reported?

The charge nurse or supervising nurse (Correct answer)
The facility administrator
The resident's family member
The pharmacist

Correct answer: The charge nurse or supervising nurse

Any change in condition following insulin administration must be reported immediately to the charge nurse, who is responsible for clinical decision-making.

Question 42: A QMA finds an insulin vial that has been left out of the refrigerator for an unknown period of time. What is the safest action?

Return it to the refrigerator and use it as normal
Use the vial immediately before it degrades further
Test the insulin on a blood glucose meter to check potency
Discard the vial and report the situation to the nurse (Correct answer)

Correct answer: Discard the vial and report the situation to the nurse

When the storage history of insulin is unknown, the safest action is to discard it and report to the supervising nurse to ensure resident safety.

Question 43: Which of the following best describes the purpose of a return demonstration in QMA insulin training?

To teach QMAs how to order insulin from the pharmacy
To verify that the QMA can safely perform the skill independently (Correct answer)
To test the QMA's knowledge of insulin pharmacology
To allow QMAs to observe a nurse perform a procedure once

Correct answer: To verify that the QMA can safely perform the skill independently

Return demonstrations allow the evaluating nurse to verify that the QMA can safely and correctly perform the insulin administration skill independently.

Question 44: When using a glucometer, the QMA should verify the device is working correctly by:

Testing it on themselves first
Checking that the screen lights up
Asking another staff member if it looked fine yesterday
Running a quality control solution check as per facility policy (Correct answer)

Correct answer: Running a quality control solution check as per facility policy

Quality control checks with control solution verify glucometer accuracy and are required per facility policy and manufacturer guidelines.

Question 45: A QMA is asked to adjust a resident's sliding scale insulin dose based on the nurse's verbal instruction over the phone. What is the correct action?

Ask another QMA to confirm the verbal order first
Administer the adjusted dose as instructed verbally
Refuse and wait for a written or verified order before making any change (Correct answer)
Adjust the dose and document it as a verbal order

Correct answer: Refuse and wait for a written or verified order before making any change

QMAs must follow written, authorized orders and should not adjust insulin doses based solely on verbal phone instructions without proper documentation.

Question 46: A QMA is certified to administer insulin but is assigned to a unit where insulin pens are used instead of vials and syringes. What must occur first?

The QMA should receive competency verification for insulin pen use before administering (Correct answer)
The QMA can proceed since insulin delivery method does not matter
The QMA should refuse to work on that unit
The QMA should ask another QMA to demonstrate once and then proceed independently

Correct answer: The QMA should receive competency verification for insulin pen use before administering

Competency with the specific delivery device must be verified before the QMA independently uses an insulin pen in clinical practice.

Question 47: Which site rotation principle reduces the risk of lipohypertrophy during insulin injection?

Inject at least 1 inch away from the previous injection site (Correct answer)
Use only the abdomen to ensure consistent absorption
Rotate injections within the same anatomical region each week
Alternate between the arm and thigh every injection

Correct answer: Inject at least 1 inch away from the previous injection site

Spacing injections at least 1 inch from the previous site prevents fatty tissue buildup (lipohypertrophy) that impairs absorption.

Question 48: A QMA is delegated insulin administration for a new resident. What must occur before the first dose is given?

A current, valid written medication order must be reviewed and confirmed (Correct answer)
The QMA must observe the nurse administer the first dose
The QMA must obtain a separate certification from the facility medical director
The resident's family must provide written consent to the QMA specifically

Correct answer: A current, valid written medication order must be reviewed and confirmed

A valid written medication order is a prerequisite that must be confirmed before any medication, including insulin, is administered.

Question 49: A QMA notices the glucometer displays an error code after inserting the test strip. What should be done?

Consult the device manual and notify the nurse (Correct answer)
Use an estimate based on symptoms
Increase the blood sample size and retry
Reuse the strip after blotting it dry

Correct answer: Consult the device manual and notify the nurse

Error codes indicate a device or strip problem; the QMA should check the manual, resolve the issue if possible, and notify the nurse of the delay.

Question 50: Which of the following sites has the fastest rate of insulin absorption?

Thigh
Buttocks
Upper Arm
Abdomen (Correct answer)

Correct answer: Abdomen

The abdomen is the preferred site for insulin injections because it provides the most rapid and predictable absorption of insulin compared to other sites like the thigh, buttocks, or arm. The rate of absorption is slowest from the buttocks and thighs.

Question 51: Why is site rotation important when administering insulin?

To reduce the risk of lipohypertrophy (Correct answer)
To increase insulin potency
To prevent hypoglycemia
To reduce injection pain only

Correct answer: To reduce the risk of lipohypertrophy

Rotating injection sites prevents lipohypertrophy, which is the buildup of fatty tissue that can impair insulin absorption.

Question 52: A resident refuses their insulin injection. What is the QMA's legal obligation?

Administer it anyway to prevent harm
Contact the family first before notifying the nurse
Wait an hour and try again without notifying anyone
Document the refusal and notify the nurse immediately (Correct answer)

Correct answer: Document the refusal and notify the nurse immediately

Residents have the right to refuse treatment, and the QMA must document the refusal and promptly notify the supervising nurse.

Question 53: A resident receiving regular insulin before meals should be monitored most closely for hypoglycemia during which timeframe?

Immediately upon injection (0–15 minutes)
6–8 hours after injection
30 minutes to 3 hours after injection (peak action time) (Correct answer)
Only overnight while sleeping

Correct answer: 30 minutes to 3 hours after injection (peak action time)

Regular insulin peaks approximately 2–3 hours after injection, which is when the risk of hypoglycemia is greatest.

Question 54: 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 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
The patient received a double dose due to pen malfunction

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 55: Which element is REQUIRED in every insulin administration entry on the MAR?

Time, dose, site, and initials of the QMA (Correct answer)
The brand name of the insulin manufacturer
The resident's insurance provider
The prescribing physician's home phone number

Correct answer: Time, dose, site, and initials of the QMA

Every MAR entry must include the time, dose administered, injection site, and the QMA's initials as a legal record.

Question 56: What does 'U-100' printed on an insulin vial label indicate?

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

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 57: A QMA administers insulin but forgets to document it until two hours later. How should the late entry be handled?

Document it as if it occurred at the current time with no explanation
Write the entry with the current time and note 'late entry — actual time of administration was [time]' (Correct answer)
Ask a coworker to document it as part of their shift entries
Do not document it at all since too much time has passed

Correct answer: Write the entry with the current time and note 'late entry — actual time of administration was [time]'

Late entries are acceptable but must be clearly labeled 'late entry' with the actual time of administration so the record accurately reflects when care occurred.

Question 58: 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
Consult the supervising nurse and review medication information before administering (Correct answer)
Ask the resident to explain the medication
Administer it since it is prescribed and assume it works the same

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 59: What must a QMA ensure before administering insulin to a patient?

The patient has signed a waiver for insulin administration
The patient agrees to receive insulin based on their emotional state
The insulin is drawn from the correct vial, regardless of label
The supervising nurse has written a specific order for the insulin dosage (Correct answer)

Correct answer: The supervising nurse has written a specific order for the insulin dosage

Before administering any medication, especially insulin which is a high-alert medication, a QMA must always ensure there is a current, written order from a licensed healthcare provider. This order specifies the insulin type, dosage, and frequency, ensuring the correct medication is given to the correct patient. Administering insulin without a valid order is a serious breach of protocol and patient safety.

Question 60: Which documentation entry is written correctly for a blood glucose check?

Blood glucose 142 mg/dL at 0730, insulin administered per sliding scale (Correct answer)
BG was fine this morning
Glucose normal, no issues noted
Patient seemed okay, gave shot

Correct answer: Blood glucose 142 mg/dL at 0730, insulin administered per sliding scale

Complete documentation includes the specific value, time, and action taken, avoiding vague or subjective language.

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%

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