QMAP Certification Exam — Questions and Answers

Question 1: What does "PRN" stand for in medication administration?

Qualified
As needed (Correct answer)
By mouth
Before bedtime

Correct answer: As needed

Explanation: <br> "PRN" is a medical abbreviation that stands for "pro re nata," which means "as needed" in Latin. It indicates that a medication should be administered only when necessary, based on the patient's condition or symptoms.

Question 2: A QMAP is about to administer oral medications and realizes their hands feel clean but they have not yet washed them. What is the correct action?

Use alcohol-based hand sanitizer if no visible soiling is present (Correct answer)
Wipe hands with a dry paper towel before continuing
Proceed because the medications are oral and will not be touched
Ask another staff member to administer the medications

Correct answer: Use alcohol-based hand sanitizer if no visible soiling is present

When hands are not visibly soiled, alcohol-based hand sanitizer is an acceptable and effective alternative to handwashing before medication administration.

Question 3: Why is accurate time documentation important on the MAR?

To help plan meal times
Only for insurance billing
For staff scheduling
To ensure proper dosing intervals and provide a legal record (Correct answer)

Correct answer: To ensure proper dosing intervals and provide a legal record

Accurate times ensure safe dosing intervals, prevent premature re-dosing, and provide a legal timeline.

Question 4: A resident has a PRN Schedule II pain medication. They request it 2 hours after the last dose, but the order says every 4 hours. What should the QMAP do?

Explain the timing requirement and notify the supervising nurse (Correct answer)
Give a half dose
Administer since the resident is in pain
Document that the resident refused to wait

Correct answer: Explain the timing requirement and notify the supervising nurse

Follow the prescribed interval. Explain to the resident and notify the nurse about uncontrolled pain.

Question 5: Which strategy is MOST effective in preventing medication errors during administration?

Having one person prepare and another administer
Relying on memory rather than the MAR
Performing three checks: when retrieving, preparing, and administering (Correct answer)
Administering as quickly as possible

Correct answer: Performing three checks: when retrieving, preparing, and administering

The three-check system catches errors at multiple points before the medication reaches the resident.

Question 6: Which of the following is OUTSIDE the scope of practice for a QMAP?

Administering medications through a feeding tube (PEG tube) (Correct answer)
Pouring oral medications from a labeled container
Applying a prescribed topical cream to intact skin
Assisting a resident in using a prescribed metered-dose inhaler

Correct answer: Administering medications through a feeding tube (PEG tube)

Administering medications through a feeding tube is a clinical skill generally outside the QMAP scope of practice and requires a licensed nurse.

Question 7: After a resident refuses their morning medication, what is the most critical documentation task for the QMAP?

Circle their initials on the MAR, and write the reason for the refusal on the back or in the notes section as per facility policy. (Correct answer)
Ask the resident to sign a special refusal form for every dose they skip.
Write a detailed note in the facility's communication log about the resident's mood.
Call the resident's family to inform them of the refusal.

Correct answer: Circle their initials on the MAR, and write the reason for the refusal on the back or in the notes section as per facility policy.

Proper documentation on the Medication Administration Record (MAR) is a legal and safety requirement. The standard procedure for a refusal is to circle the QMAP's initials in the corresponding time slot and document the reason on the back of the MAR or in a designated notes area. This creates a clear and immediate record for all staff.

Question 8: A QMAP and an off-going staff member are performing a shift-change count of a resident's controlled substances. They discover that the number of oxycodone tablets in the package does not match the number documented on the controlled substance record sheet. What is the immediate, priority action?

Administer the next scheduled dose to avoid a delay in the resident's pain management.
Document the correct count on the record sheet and have both staff members sign it.
Report the discrepancy to the facility supervisor or nurse immediately before any doses are given. (Correct answer)
Borrow a tablet from another resident's supply to make the count correct and report it later.

Correct answer: Report the discrepancy to the facility supervisor or nurse immediately before any doses are given.

Any discrepancy in a controlled substance count is a serious issue that must be reported to a supervisor immediately for investigation. This must be done before any further doses are administered to ensure accountability and resident safety, and to follow facility policy and state regulations.

Question 9: What is a "near miss" in the context of medication errors?

A dose that was almost correct
An error that caused only minor harm
An error involving a nearly expired medication
An error caught before the medication reached the resident (Correct answer)

Correct answer: An error caught before the medication reached the resident

A near miss is detected and intercepted before it could reach the resident.

Question 10: Which of the following best describes the relationship between a QMAP and the facility's licensed nursing staff?

QMAPs operate independently and report only to the facility administrator
QMAPs work under the supervision of licensed nurses, who provide clinical oversight and guidance (Correct answer)
The nurse and QMAP have completely separate, unrelated roles
QMAPs supervise unlicensed aides in all medication tasks

Correct answer: QMAPs work under the supervision of licensed nurses, who provide clinical oversight and guidance

QMAPs operate under the clinical supervision of licensed nurses, who are responsible for oversight of medication administration activities.

Question 11: Which of the following is a specific documentation requirement for administering a controlled substance that is different from documenting a non-controlled medication like an antibiotic?

Documenting the resident's allergies before giving the first dose.
Initialing the MAR after the medication has been successfully administered.
Recording the date and time of administration on the Medication Administration Record (MAR).
Maintaining a perpetual inventory or running count on a separate controlled substance record sheet. (Correct answer)

Correct answer: Maintaining a perpetual inventory or running count on a separate controlled substance record sheet.

In addition to documenting on the MAR, every dose of a controlled substance must be logged on a separate, dedicated record sheet. This sheet maintains a running count (perpetual inventory) that is physically verified against the remaining medication at least at every shift change.

Question 12: A resident is prescribed Furosemide (Lasix), which is a diuretic. When planning for the resident's day, which common and expected side effect should the QMAP anticipate?

Increased appetite
Constipation
Dry, hacking cough
Increased frequency of urination (Correct answer)

Correct answer: Increased frequency of urination

Furosemide is a loop diuretic that works by helping the kidneys remove excess salt and water from the body through urine. Therefore, an increased frequency of urination is the most direct and expected effect after administration.

Question 13: A resident takes both a sedative and an opioid. What concern should the QMAP have?

No concern
They cancel each other out
The resident will develop immunity quickly
Both depress the CNS, increasing risk of excessive sedation and respiratory depression (Correct answer)

Correct answer: Both depress the CNS, increasing risk of excessive sedation and respiratory depression

Combining CNS depressants creates additive effects that significantly increase the risk of dangerous sedation and respiratory depression.

Question 14: Which is a common sign of opioid overdose?

High blood pressure and flushed skin
Extremely slow or stopped breathing with pinpoint pupils (Correct answer)
Increased alertness and tremors
Rapid breathing and agitation

Correct answer: Extremely slow or stopped breathing with pinpoint pupils

The classic triad: respiratory depression, pinpoint pupils (miosis), and decreased consciousness.

Question 15: What is the minimum recommended duration for handwashing with soap and water according to infection control guidelines?

5 seconds
20 seconds (Correct answer)
60 seconds
10 seconds

Correct answer: 20 seconds

The CDC recommends scrubbing hands with soap and water for at least 20 seconds to effectively remove pathogens.

Question 16: What information must be recorded each time a controlled substance is administered?

Only medication name and dose
Only date and resident name
Just initials on the MAR
Date, time, resident name, medication, dose, and administering staff signature (Correct answer)

Correct answer: Date, time, resident name, medication, dose, and administering staff signature

Complete documentation includes date, time, resident ID, medication, dose, route, running balance, and full signature.

Question 17: When administering eye drops, where should the drops be placed?

In the lower conjunctival sac (Correct answer)
Directly on the cornea
At the outer corner of the closed eye
On the upper eyelid

Correct answer: In the lower conjunctival sac

Drops go in the lower conjunctival sac, formed by gently pulling down the lower eyelid.

Question 18: What is the primary difference between topical and systemic medication routes?

There is no difference
Systemic is only given by injection
Topical acts locally at the application site; systemic delivers throughout the body via bloodstream (Correct answer)
Topical is always safer

Correct answer: Topical acts locally at the application site; systemic delivers throughout the body via bloodstream

Topical medications act at the application site, while systemic medications enter the bloodstream and affect the entire body.

Question 19: Which type of precautions apply to ALL residents, regardless of their diagnosis or infection status?

Contact precautions
Airborne precautions
Droplet precautions
Standard precautions (Correct answer)

Correct answer: Standard precautions

Standard precautions are applied universally to all residents because any person may carry infectious agents, even without a known diagnosis.

Question 20: What are Spansules commonly used for in medication administration?

Breaking substances down chemically changes substances
Gelatin capsule filled with medicated small balls- time released (Correct answer)
Fine spray application for inhalation
Gelatin capsule with powder. NO CRUSH

Correct answer: Gelatin capsule filled with medicated small balls- time released

Explanation: <br> Spansules are gelatin capsules that contain small balls of medication designed for time release. This allows for a controlled release of the medication over an extended period.

Question 21: A resident on iron supplements reports black, tarry stools. What should the QMAP know about this finding?

This is a medical emergency requiring a 911 call
Iron supplements should be stopped immediately without consulting the nurse
This is unrelated to the medication and requires no action
Black stools are an expected side effect of iron supplements and should still be reported to the nurse for documentation (Correct answer)

Correct answer: Black stools are an expected side effect of iron supplements and should still be reported to the nurse for documentation

Black stools are a known expected side effect of iron supplements, but the QMAP should still document and report this to the nurse to rule out gastrointestinal bleeding.

Question 22: A resident has a physician's order for 'Loratadine 10mg PO daily'. How should the QMAP administer this medication?

Instruct the resident to swallow the tablet with a glass of water (Correct answer)
Have the resident inhale the medication from an inhaler
Apply the medication as a cream to the resident's skin
Place the tablet under the resident's tongue to dissolve

Correct answer: Instruct the resident to swallow the tablet with a glass of water

The medical abbreviation 'PO' stands for 'per os,' which means 'by mouth.' Therefore, the medication should be swallowed. Placing it under the tongue (sublingual), applying it to the skin (topical), or inhaling it would be incorrect routes of administration.

Question 23: Which statement is a fundamental rule for documenting on the Medication Administration Record (MAR)?

Use a pencil so that any mistakes can be easily erased and corrected.
Documentation should be completed at the end of the shift to ensure accuracy.
The QMAP who prepared the medication can have another QMAP document its administration.
A QMAP must only document medications that they have personally administered or monitored. (Correct answer)

Correct answer: A QMAP must only document medications that they have personally administered or monitored.

A core principle of medication administration is that the person who administers the medication is the one who must document it. This ensures accountability and accuracy. Documentation must be done immediately after administration, not before or at the end of a shift, and always in black ink.

Question 24: A QMAP's certification has expired but the facility asks them to continue administering medications. What should the QMAP do?

Continue since the facility authorized it
Only administer non-controlled substances
Refuse until certification is renewed, as practicing without valid certification is illegal (Correct answer)
Work only with supervision

Correct answer: Refuse until certification is renewed, as practicing without valid certification is illegal

Administering without valid certification is illegal regardless of employer authorization.

Question 25: A QMAP discovers that a resident's medication was not delivered from the pharmacy and is therefore unavailable to administer at the scheduled time. This situation is considered what type of medication error?

Wrong Dose
Wrong Route
Omission/Unavailable Medication (Correct answer)
Wrong Documentation

Correct answer: Omission/Unavailable Medication

A medication error includes any failure in the medication administration process. When a medication is unavailable because it was not reordered or delivered, and this results in a missed dose, it is categorized as an error of omission or an unavailable medication. It is the facility's and QMAP's responsibility to ensure medications are available.

Question 26: What does "DC" written next to a medication on the MAR mean?

Dose changed
Delayed compliance
Discontinued (Correct answer)
Daily count

Correct answer: Discontinued

DC means "discontinued" - the medication order has been stopped by the prescriber.

Question 27: When administering a nasal spray, in which direction should the nozzle be pointed?

Toward the septum
Downward toward the floor of the nose
Toward the outer wall of the nostril, away from the septum (Correct answer)
Straight up toward the top of the head

Correct answer: Toward the outer wall of the nostril, away from the septum

Aim toward the outer wall, away from the septum, to maximize absorption and minimize irritation.

Question 28: Under which circumstance can a QMAP administer medication without consent?

Only in a genuine emergency where the resident cannot consent and delay would endanger life (Correct answer)
When family requests it
When the QMAP believes it is important
Whenever the prescriber orders it

Correct answer: Only in a genuine emergency where the resident cannot consent and delay would endanger life

Only in true emergencies: the resident cannot consent, no guardian is available, and delay would threaten life.

Question 29: You need to give 15 cc of medication. How many TBSP will you give?

1 TBSP (Correct answer)
2 TBSP
3 TBSP
1/2 TBSP

Correct answer: 1 TBSP

Explanation: <br> One tablespoon (TBSP) is equivalent to approximately 15 milliliters (ml) or cubic centimeters (cc) in volume. Therefore, when administering 15 cc of a medication, you would give 1 tablespoon to ensure the accurate dosage.

Question 30: How should a QMAP clean and maintain the medication cart to support infection control?

Wipe down the cart with an approved disinfectant at the start and end of each medication pass (Correct answer)
Clean the cart surface once a week with a damp cloth
Use soap and water to clean the cart after every medication error
Clean the cart only when it appears visibly dirty

Correct answer: Wipe down the cart with an approved disinfectant at the start and end of each medication pass

Disinfecting the medication cart before and after each medication pass reduces pathogen buildup and prevents cross-contamination during the pass.

Question 31: Which of the following situations would require a QMAP in Colorado to make a mandatory report to law enforcement?

A resident's family member is upset about the facility's visiting hours.
A resident frequently argues with staff about their medication times.
A resident has a new, unexplained bruise on their arm and seems fearful of a specific family member. (Correct answer)
A resident complains that their roommate is always stealing their snacks.

Correct answer: A resident has a new, unexplained bruise on their arm and seems fearful of a specific family member.

Colorado law designates certain professionals, including those working with at-risk elders, as mandatory reporters for suspected abuse, neglect, or exploitation. An unexplained bruise coupled with fear of a person is a significant indicator of potential physical abuse, which legally requires a report to be made to law enforcement within 24 hours.

Question 32: You need to give 1 tsp. of medication. How many cc's will you give?

5 cc (Correct answer)
2 cc
3 cc
7 cc

Correct answer: 5 cc

Explanation: <br> A teaspoon (tsp.) is a common unit of volume measurement in medication administration. One teaspoon is equivalent to approximately 5 milliliters (ml) or cubic centimeters (cc). Therefore, when administering 1 tsp. of medication, you would give 5 cc to ensure the accurate dosage.

Question 33: Which of the following is considered a medication error that a QMAP must report?

Administering a PRN medication for headache as ordered by the physician.
Crushing a tablet that is listed on the 'Do Not Crush' list before administration. (Correct answer)
Giving a resident's 9:00 AM medication at 9:15 AM within the facility's time window.
Documenting immediately on the MAR after a resident takes their medication.

Correct answer: Crushing a tablet that is listed on the 'Do Not Crush' list before administration.

A medication error includes not following accepted standards of practice or manufacturer's directions. Crushing a medication that should not be crushed (e.g., an extended-release tablet) alters its properties and is a significant administration error that must be reported. The other options describe correct procedures.

Question 34: The Medication Administration Record (MAR) directs you to administer 15 mL of a liquid oral medication. Which of the following is the correct equivalent measurement to use?

1 teaspoon
1 ounce
1 tablespoon (Correct answer)
2 tablespoons

Correct answer: 1 tablespoon

In medication measurement, 1 tablespoon (Tbsp) is equivalent to 15 milliliters (mL). A teaspoon (tsp) is 5 mL, and an ounce (oz) is 30 mL. Therefore, 15 mL is correctly measured as 1 tablespoon.

Question 35: How should medications awaiting disposal be stored?

In a separate, secured area clearly marked as awaiting disposal with controlled substances requiring witnessed disposal (Correct answer)
In regular garbage
Mixed with active medications
In an unlocked area

Correct answer: In a separate, secured area clearly marked as awaiting disposal with controlled substances requiring witnessed disposal

Medications awaiting disposal must be secured separately, labeled clearly, with controlled substances requiring witnessed destruction.

Question 36: A QMAP is reviewing a new medication order. Which of the following administration routes is within their scope of practice?

Subcutaneous injection
Transdermal patch (Correct answer)
Intravenous (IV) injection
Intramuscular injection

Correct answer: Transdermal patch

QMAPs are trained and authorized to apply transdermal patches, which is a form of topical medication administration. QMAPs are explicitly prohibited from administering any form of injection (IV, subcutaneous, intramuscular), as this is outside their scope of practice.

Question 37: A medication is ordered "PO." What route does this indicate?

Per otic (ear)
By mouth (per os) (Correct answer)
Placed on (topical)
Per ostomy

Correct answer: By mouth (per os)

PO stands for "per os," Latin for "by mouth" - the most common administration route.

Question 38: What is the primary therapeutic effect of a bronchodilator?

Reduces fever
Slows heart rate
Reduces joint inflammation
Opens airways by relaxing bronchial muscles (Correct answer)

Correct answer: Opens airways by relaxing bronchial muscles

Bronchodilators relax airway smooth muscles, widening them to improve airflow to the lungs.

Question 39: A QMAP's certification lapses. What is the implication for their medication administration duties?

They are no longer authorized to administer medications and must stop until recertified (Correct answer)
They can administer medications only under direct nurse observation
They may continue working until the renewal is processed
Certification lapse has no impact on QMAP duties

Correct answer: They are no longer authorized to administer medications and must stop until recertified

An expired QMAP certification means the individual is no longer legally authorized to administer medications and must stop until recertified.

Question 40: Which is considered falsification of the MAR?

Documenting that a medication was given when it was not administered (Correct answer)
Making a late entry clearly marked as late
Noting a resident's refusal
Correcting an error with single-line-through method

Correct answer: Documenting that a medication was given when it was not administered

Recording a medication as given when it was not administered is fraud with serious legal and professional consequences.

Question 41: An alert and competent resident tells the QMAP, "I don't want to take my blood pressure pill today, it makes me feel dizzy." What is the QMAP's most appropriate initial action?

Tell the resident they must take it because the doctor ordered it.
Wait one hour and try to administer the medication again without discussion.
Respect the resident's decision, document the refusal on the MAR, and report it to the supervisor. (Correct answer)
Crush the pill and mix it into their applesauce to make sure they get it.

Correct answer: Respect the resident's decision, document the refusal on the MAR, and report it to the supervisor.

A competent resident has the absolute right to refuse medication. The QMAP's professional responsibility is to honor that refusal, document it accurately and immediately on the Medication Administration Record (MAR), and report the refusal to their supervisor or nurse for further assessment and follow-up.

Question 42: What does the phrase 'working within your scope of practice' mean for a QMAP?

Performing any task requested by a supervisor regardless of training
Following resident preferences over standard protocols
Performing only the medication administration tasks for which you are trained, authorized, and certified (Correct answer)
Doing whatever is needed in an emergency regardless of training

Correct answer: Performing only the medication administration tasks for which you are trained, authorized, and certified

Working within scope of practice means performing only those tasks for which you hold proper training, certification, and authorization.

Question 43: A physician orders 0.5 grams of a medication for a resident. The medication is only available in 250 mg tablets. How many tablets should the QMAP administer?

4 tablets
0.5 tablets
2 tablets (Correct answer)
1 tablet

Correct answer: 2 tablets

The order is in grams, but the tablets are in milligrams. First, convert grams to milligrams. There are 1,000 milligrams (mg) in 1 gram (g). Therefore, 0.5 g is equal to 500 mg (0.5 x 1000). Next, divide the required dose (500 mg) by the strength of each tablet (250 mg), which equals 2. (500 mg / 250 mg = 2).

Question 44: What documentation should the QMAP maintain regarding their own certification and training?

Personal copies of certification, training records, continuing education, and delegation documents (Correct answer)
Only current year records
Only the initial certificate
No personal records needed

Correct answer: Personal copies of certification, training records, continuing education, and delegation documents

Maintain comprehensive personal records for professional protection and proving qualifications.

Question 45: After administering medications to a resident and before moving to the next resident, which of the following is the MOST important infection control step?

Document the medication on the MAR
Restock the medication cart
Check the next resident's allergies
Perform hand hygiene (Correct answer)

Correct answer: Perform hand hygiene

Performing hand hygiene between residents is the most critical infection control step to prevent cross-contamination of pathogens from one resident to another.

Question 46: A QMAP is organizing the medication cart. To prevent administration errors, how must medications for internal use (oral) be stored in relation to medications for external use (topical)?

They can be stored on the same shelf if they are in different colored packaging.
They can be stored together if they are for the same resident.
They must be stored separately from each other within the locked medication area. (Correct answer)
They must be stored in completely different medication carts.

Correct answer: They must be stored separately from each other within the locked medication area.

To prevent the accidental ingestion of a topical or other external-use-only product, regulations require that internal and external medications be stored in separate, designated areas within the locked cart or room.

Question 47: A resident is prescribed eye drops for glaucoma. When administering the medication, the QMAP should instill the drops into which specific location?

The conjunctival sac of the lower eyelid (Correct answer)
The upper eyelid while it is closed
Directly onto the center of the cornea
The inner corner of the eye near the nose

Correct answer: The conjunctival sac of the lower eyelid

The correct and safe procedure for administering eye drops is to gently pull down the lower eyelid to create a small pocket, known as the conjunctival sac, and instill the prescribed number of drops there. This prevents injury to the cornea and allows the medication to be distributed effectively across the eye.

Question 48: A resident has a new medication that must be kept refrigerated. Which of the following is the correct storage procedure for this medication?

In a locked medication refrigerator or a locked box inside a shared refrigerator. (Correct answer)
In any available refrigerator, as long as the temperature is correct.
In the staff break room refrigerator, as long as it is labeled.
In the resident's personal mini-fridge in their room.

Correct answer: In a locked medication refrigerator or a locked box inside a shared refrigerator.

Medications requiring refrigeration must be kept at the proper temperature and secured from unauthorized access. Regulations specify they must be stored in a refrigerator that does not contain food and is not accessible to residents, or in a locked container within a shared refrigerator.

Question 49: A resident is prescribed 500 mg of a medication. The tablets available are 250 mg each. How many tablets should be administered?

3 tablets
1.5 tablets
2 tablets (Correct answer)
1 tablet

Correct answer: 2 tablets

500 mg divided by 250 mg per tablet equals 2 tablets.

Question 50: How should insulin currently in use be stored?

Always in the freezer
Same as other medications without special consideration
At room temperature for up to 28 days or refrigerated per guidelines (Correct answer)
In direct sunlight

Correct answer: At room temperature for up to 28 days or refrigerated per guidelines

Opened insulin can be stored at room temperature up to 28 days. Unopened insulin should be refrigerated.

Question 51: During a medication pass, a QMAP realizes they administered a resident's morning medication to the wrong person. What is the QMAP's immediate legal and ethical responsibility?

Document the error on the MAR and hope neither resident has an adverse reaction.
Immediately report the error to their supervisor or the facility nurse. (Correct answer)
Administer the correct medication to the resident who missed it.
Ask the resident who received the wrong medication if they feel okay.

Correct answer: Immediately report the error to their supervisor or the facility nurse.

When a medication error occurs, the QMAP's primary legal and ethical duty is to ensure resident safety and report the incident immediately to a licensed supervisor, such as an RN or LPN. This allows for prompt assessment of both residents involved and the implementation of any necessary interventions. Hiding an error or attempting to correct it independently is a serious breach of protocol and safety standards.

Question 52: A resident who is taking a prescribed opioid medication for pain reports having difficult and infrequent bowel movements. The QMAP should recognize this as which very common side effect of this drug class?

Constipation (Correct answer)
Dehydration
Diarrhea
Drowsiness

Correct answer: Constipation

Opioids affect the gastrointestinal tract by decreasing motility, which leads to hard, dry stools and infrequent bowel movements. Constipation is one of the most common side effects of chronic opioid use, and tolerance to this effect rarely develops.

Question 53: How should used medication cups and disposable medication supplies be disposed of after a medication pass to support infection control?

Rinse and reuse them for the next medication pass
Place them in the regular trash, away from clean supplies (Correct answer)
Leave them on the medication cart for later cleaning
Return unused portions to the medication stock bottle

Correct answer: Place them in the regular trash, away from clean supplies

Used single-use medication cups and disposable supplies should be placed in the trash and kept separate from clean supplies to prevent contamination of the medication preparation area.

QMAP Certification Exam

The Colorado QMAP exam certifies unlicensed personnel to safely administer medications in approved care settings under the Seven Rights framework.

Questions

60 min

Time Limit

80%

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