QMA Insulin Documentation and Reporting 2 — Questions and Answers
Question 1: A resident refuses insulin at 0800. What must the QMA document in the medication administration record (MAR)?
- Administer anyway and document compliance
- Mark the dose as given to avoid paperwork
- Record the refusal, reason if given, and notify the nurse (Correct answer)
- Skip documentation since the dose was not given
Correct answer: Record the refusal, reason if given, and notify the nurse
Refusals must be documented on the MAR with the reason if known, and the nurse must be notified promptly.
Question 2: When documenting insulin administration, which blood glucose value would require the QMA to withhold the dose AND document a parameter hold?
- 110 mg/dL
- 145 mg/dL
- 58 mg/dL (Correct answer)
- 180 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 3: Which element is REQUIRED in every insulin administration entry on the MAR?
- The resident's insurance provider
- Time, dose, site, and initials of the QMA (Correct answer)
- The prescribing physician's home phone number
- The brand name of the insulin manufacturer
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 4: A QMA notices the previous shift's insulin entry has no initials. What is the appropriate action?
- Add your own initials to complete the record
- Leave it blank and document a note about it
- Report the incomplete entry to the charge nurse (Correct answer)
- White-out the entry and re-write it correctly
Correct answer: Report the incomplete entry to the charge nurse
Incomplete documentation by another staff member must be reported to the charge nurse rather than altered by the QMA.
Question 5: What is the correct procedure if a QMA makes a documentation error on the MAR?
- Use correction fluid to cover the mistake
- Draw a single line through the error, initial, and date it (Correct answer)
- Erase the error completely and rewrite the entry
- Tear out the page and start a new MAR
Correct answer: Draw a single line through the error, initial, and date it
Errors are corrected by drawing a single line through the mistake, then initialing and dating — this preserves the original entry for legal purposes.
Question 6: After administering insulin, a resident develops shakiness and diaphoresis. What must the QMA document FIRST?
- The resident's meal preferences
- 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
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 7: The pharmacy delivers a new insulin pen for a resident. Before administering from the new pen, the QMA should verify and document which of the following?
- That the pen matches the resident's name, insulin type, and concentration on the MAR (Correct answer)
- That the pen has a full cartridge regardless of the order
- Only the expiration date
- The pen's serial number in the nursing notes
Correct answer: That the pen matches the resident's name, insulin type, and concentration on the MAR
The QMA must verify and document that the pen label matches the resident's name, prescribed insulin type, and concentration before administration.
QMA Insulin Documentation and Reporting 2
A resident refuses insulin at 0800.
What must the QMA document in the medication administration record (MAR)?