QMA Insulin Monitoring and Documentation 3 — Questions and Answers
Question 1: A resident refuses to have their blood glucose checked before insulin administration. The QMA should:
- Administer the insulin anyway using the last recorded value
- Respect the refusal, document it, and notify the nurse (Correct answer)
- Physically restrain the resident to obtain the reading
- Skip both the glucose check and the insulin dose without reporting
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 2: Which documentation entry is written correctly for a blood glucose check?
- BG was fine this morning
- Blood glucose 142 mg/dL at 0730, insulin administered per sliding scale (Correct answer)
- Patient seemed okay, gave shot
- Glucose normal, no issues noted
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.
Question 3: A QMA makes a documentation error in the paper medication record. The correct procedure is to:
- Use correction fluid to cover the mistake
- Scribble out the error completely
- Draw a single line through the error, initial it, and write the correct entry (Correct answer)
- Tear out the page and start over
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 4: After administering insulin, the QMA should monitor the resident for signs of hypoglycemia for at least:
- 5 minutes
- 30–60 minutes (Correct answer)
- 24 hours continuously
- Only if the resident complains
Correct answer: 30–60 minutes
Insulin onset varies by type, but monitoring for hypoglycemia for 30–60 minutes post-administration captures most early reactions.
Question 5: A blood glucose meter displays 'HI' instead of a number. This MOST likely means:
- The battery is low
- The blood glucose exceeds the meter's measurement range (usually >600 mg/dL) (Correct answer)
- The test strip is expired
- The resident is in a good mood
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 6: Which of the following BEST describes the purpose of a sliding scale insulin protocol in documentation?
- It allows the QMA to choose any insulin dose they prefer
- It provides a pre-ordered dosing guide based on specific blood glucose ranges (Correct answer)
- It replaces the need to check blood glucose
- It is only used during emergencies
Correct answer: It provides a pre-ordered dosing guide based on specific blood glucose ranges
A sliding scale is a physician-ordered protocol that matches insulin doses to specific blood glucose readings to maintain glycemic control.
Question 7: If a resident's blood glucose is 400 mg/dL and the sliding scale ends at 350 mg/dL, the QMA should:
- Administer the highest dose on the scale and document it
- Notify the nurse immediately, as the reading is outside the protocol range (Correct answer)
- Double the last listed insulin dose
- Recheck the glucose in one hour before acting
Correct answer: Notify the nurse immediately, as the reading is outside the protocol range
A reading outside the sliding scale range requires nurse notification; the QMA cannot independently extrapolate dosing beyond the ordered protocol.
QMA Insulin Monitoring and Documentation 3
A resident refuses to have their blood glucose checked before insulin administration.
The QMA should: