QMA Insulin Safety and Emergency Procedures 3 — Questions and Answers
Question 1: A resident who takes insulin develops sudden diaphoresis (sweating), pallor, and confusion during the night shift. The QMA's priority is to:
- Check blood glucose immediately and notify the nurse (Correct answer)
- Wait until morning assessment to report the change
- Offer water and reassess in 30 minutes
- Administer the next scheduled insulin dose
Correct answer: Check blood glucose immediately and notify the nurse
Diaphoresis, pallor, and confusion are classic signs of hypoglycemia requiring immediate glucose check and nurse notification.
Question 2: Which insulin storage error poses the greatest safety risk to a resident?
- Using insulin that has been frozen and then thawed (Correct answer)
- Storing an unopened vial in the refrigerator
- Keeping a opened vial at room temperature for 28 days
- Rolling the vial gently before drawing up cloudy insulin
Correct answer: Using insulin that has been frozen and then thawed
Freezing destroys insulin protein structure, rendering it ineffective and potentially harmful if administered.
Question 3: A QMA accidentally administers insulin to the wrong resident. The first action after discovering the error is to:
- Assess the resident and notify the nurse immediately (Correct answer)
- Complete the incident report before notifying anyone
- Administer glucose to prevent hypoglycemia proactively
- Monitor the resident quietly and report at shift change
Correct answer: Assess the resident and notify the nurse immediately
Patient safety requires immediate clinical assessment and nurse notification so that monitoring and interventions can begin at once.
Question 4: When is it appropriate for a QMA to administer glucagon?
- Never — glucagon administration is outside the QMA scope of practice (Correct answer)
- When blood glucose is below 70 mg/dL in a conscious resident
- When oral glucose is unavailable and the resident is unconscious
- After the nurse orders it verbally over the phone
Correct answer: Never — glucagon administration is outside the QMA scope of practice
Glucagon injection is a nursing/medical intervention that falls outside the QMA's authorized scope of practice.
Question 5: Which finding would cause a QMA to withhold an insulin dose and notify the nurse WITHOUT attempting to treat?
- Blood glucose of 45 mg/dL in an unconscious resident (Correct answer)
- Blood glucose of 110 mg/dL with no symptoms
- Mild injection site bruising from yesterday's dose
- Resident complaint of mild hunger before the dose
Correct answer: Blood glucose of 45 mg/dL in an unconscious resident
An unconscious resident with critically low glucose requires emergency intervention that is beyond the QMA's independent treatment authority.
Question 6: To prevent insulin pen cross-contamination between residents, the QMA must:
- Assign one pen per resident and never share pens between residents (Correct answer)
- Replace the pen needle after every two uses
- Store all resident pens together in the medication refrigerator
- Wipe the pen cartridge with alcohol between residents
Correct answer: Assign one pen per resident and never share pens between residents
Sharing insulin pens, even with needle changes, risks bloodborne pathogen transmission and is strictly prohibited.
Question 7: A resident with type 1 diabetes who takes insulin develops sudden severe headache and slurred speech. The QMA should FIRST:
- Call 911 and notify the nurse simultaneously (Correct answer)
- Check blood glucose and treat for hypoglycemia
- Offer juice and wait 15 minutes to reassess
- 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.
QMA Insulin Safety and Emergency Procedures 3
A resident who takes insulin develops sudden diaphoresis (sweating), pallor, and confusion during the night shift.
The QMA's priority is to: