Qualified Medication Aide QMA Final Practice
ACTUAL EXAM 2026/2027 | Complete Exam-
Style Questions | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Medication Administration (Questions 1-25)
Q1: During a morning med pass, the QMA notices that the blister card for a resident has "Metoprolol 25
mg" but the MAR (Medication Administration Record) shows "Metoprolol 50 mg." The QMA has not yet
removed the medication. What is the MOST appropriate action?
A. Administer the 25 mg and document it, then notify the nurse after the med pass
B. Crush the 25 mg tablet and give it to avoid missing the dose entirely
C. Hold the medication, notify the supervising nurse immediately, and do not administer until the
discrepancy is resolved [CORRECT]
D. Give 25 mg now and offer an extra 25 mg from a different resident's cart later
Correct Answer: C
Rationale: The correct answer is C because the Six Rights include "right dose" and "right medication."
Any discrepancy between the MAR and medication supply requires stopping the med pass for that drug
and immediately notifying the supervising nurse — before administration. Distractor A is wrong because
administering an incorrect dose violates QMA scope and resident safety; documentation does not
retroactively fix the error. Distractor B is dangerous — crushing metoprolol (not safe) and ignoring the
dose mismatch. Distractor D is a medication error (taking from another resident) and potentially a
controlled substance violation if that other cart contains scheduled drugs. Clinical Pearl: QMAs are
never responsible for resolving order discrepancies — only for identifying them, holding, and reporting
up.
Q2: A resident is prescribed an enteric-coated aspirin 81 mg daily. The resident refuses to swallow the
tablet whole and requests that it be crushed and mixed with applesauce. What should the QMA do?
A. Crush the tablet and mix with applesauce as requested
B. Crush the tablet only if the family consents
C. Do not crush the tablet; notify the supervising nurse and document the resident's refusal [CORRECT]
D. Hide the crushed tablet in ice cream without telling the resident
,Correct Answer: C
Rationale: The correct answer is C because enteric-coated medications are designed to bypass gastric
acid and dissolve in the intestines; crushing destroys the protective coating, causing gastric irritation and
altering drug absorption. QMAs cannot alter medication formulation without a nurse or prescriber
order. Distractor A violates medication safety — crushing an enteric-coated tablet is never appropriate.
Distractor B incorrectly delegates clinical decision-making to family members rather than nursing staff.
Distractor D constitutes deception in medication administration, which violates resident rights and
informed consent principles. Clinical Pearl: "Do not crush" medications include enteric-coated,
sustained-release, sublingual, and certain chemotherapy drugs — always verify before crushing.
Q3: The QMA is preparing to administer a sublingual nitroglycerin tablet to a resident experiencing chest
pain. The QMA should instruct the resident to:
A. Swallow the tablet with a full glass of water
B. Chew the tablet thoroughly before swallowing
C. Place the tablet under the tongue and allow it to dissolve completely without swallowing [CORRECT]
D. Crush the tablet and mix with water
Correct Answer: C
Rationale: The correct answer is C because sublingual nitroglycerin is absorbed through the rich vascular
network under the tongue, bypassing first-pass hepatic metabolism and providing rapid onset of action
(1-3 minutes). Swallowing the tablet would delay absorption and reduce effectiveness. Distractor A
destroys the sublingual route advantage and delays therapeutic effect. Distractor B (chewing) is
incorrect for sublingual tablets — chewing may alter absorption kinetics. Distractor D is never
appropriate for sublingual medications and would render the drug ineffective. Clinical Pearl: Sublingual
nitroglycerin administration requires the resident to avoid eating, drinking, or smoking for 5 minutes
before and after administration to ensure proper absorption.
Q4: A resident's MAR indicates "Furosemide 40 mg PO daily at 0800." The QMA checks the medication
cart and finds only Furosemide 20 mg tablets. What is the correct action?
A. Give two 20 mg tablets to equal the ordered 40 mg dose
B. Hold the medication and notify the supervising nurse immediately [CORRECT]
C. Give one 20 mg tablet and document a partial dose
D. Borrow a 40 mg tablet from another resident's supply
Correct Answer: B
Rationale: The correct answer is B because QMAs cannot independently determine equivalent dosing or
substitute tablet quantities without nursing verification. The MAR specifies 40 mg, and only 20 mg
tablets are available — this is a supply discrepancy that requires nurse intervention to verify whether
,two 20 mg tablets are appropriate or if the order needs clarification. Distractor A assumes equivalence
without authorization and bypasses the verification process. Distractor C administers a subtherapeutic
dose without authorization. Distractor D violates medication security, resident privacy, and controlled
substance regulations. Clinical Pearl: "Give two of X to equal Y" seems logical but requires nurse
verification — tablet splitting, doubling, or substitution always needs RN/LPN approval.
Q5: The QMA is transcribing a new physician order: "Warfarin 5 mg PO daily, hold if INR > 4.0." The QMA
should:
A. Transcribe the order as written and place a reminder note in the MAR
B. Transcribe the order and notify the nurse that a hold parameter is present [CORRECT]
C. Ignore the hold parameter and give the medication daily regardless of INR
D. Refuse to transcribe the order because QMAs cannot administer anticoagulants
Correct Answer: B
Rationale: The correct answer is B because QMAs can administer oral anticoagulants under supervision,
but hold parameters (such as INR > 4.0) require nursing oversight for lab value verification and clinical
decision-making. The QMA must transcribe the order accurately and immediately notify the nurse that a
hold parameter exists. Distractor A fails to alert nursing to the need for lab monitoring and hold protocol
activation. Distractor C ignores a critical safety parameter and could cause bleeding complications.
Distractor D is incorrect — QMA scope typically includes oral anticoagulant administration with proper
training and supervision. Clinical Pearl: Any order with hold parameters, sliding scales, or lab-dependent
dosing requires immediate nursing notification to ensure monitoring protocols are established.
Q6: A resident is prescribed an ophthalmic eye drop (Timolol 0.5%) one drop in the right eye twice daily.
The QMA should:
A. Instill the drop onto the center of the cornea
B. Instill the drop into the conjunctival sac (lower eyelid pocket) and instruct the resident to close the
eye gently for 1-2 minutes [CORRECT]
C. Instill two drops to ensure adequate medication delivery
D. Touch the dropper tip to the eyelid to stabilize it
Correct Answer: B
Rationale: The correct answer is B because ophthalmic drops are instilled into the conjunctival sac (the
pocket formed by pulling down the lower eyelid) to maximize contact with the ocular surface and
minimize systemic absorption. Gentle eye closure for 1-2 minutes with nasolacrimal duct pressure
prevents drainage into the nasal mucosa. Distractor A risks corneal irritation and reflex tearing that
washes out the medication. Distractor C delivers excess medication that increases systemic absorption
and waste. Distractor D contaminates the dropper tip and risks cross-contamination between residents.
, Clinical Pearl: When administering multiple eye drops, wait 5 minutes between medications to prevent
washout; always administer drops before ointments.
Q7: The QMA is preparing an inhaled bronchodilator (albuterol) via metered-dose inhaler (MDI) with a
spacer. The correct technique includes:
A. Shaking the canister, attaching the spacer, pressing the canister once, and having the resident
breathe normally through the spacer [CORRECT]
B. Pressing the canister multiple times rapidly to ensure adequate dose delivery
C. Having the resident exhale into the spacer before actuation
D. Removing the spacer because it reduces medication delivery
Correct Answer: A
Rationale: The correct answer is A because the MDI with spacer technique requires shaking the canister
to mix the medication, attaching the spacer to slow particle velocity and improve lung deposition,
actuating one puff into the spacer, and having the resident breathe slowly and deeply through the
mouthpiece. Distractor B causes medication overdose and increased side effects (tachycardia, tremors).
Distractor C forces exhaled air (with CO2 and moisture) into the spacer, potentially affecting medication
stability. Distractor D contradicts evidence-based practice — spacers significantly improve MDI delivery
to the lungs and reduce oropharyngeal deposition. Clinical Pearl: Wait 30-60 seconds between puffs
when multiple actuations are ordered to allow airway receptors to respond and improve drug
distribution.
Q8: A resident's MAR shows "Multivitamin 1 tablet PO daily" but the resident is currently NPO (nothing
by mouth) for a scheduled procedure. What should the QMA do?
A. Crush the multivitamin and administer via feeding tube
B. Hold the medication and notify the supervising nurse [CORRECT]
C. Give the tablet with a small sip of water, assuming the NPO order doesn't apply to medications
D. Place the tablet under the resident's tongue for sublingual absorption
Correct Answer: B
Rationale: The correct answer is B because NPO status applies to all oral medications unless specifically
exempted by the physician or nurse. QMAs cannot independently determine which medications are safe
to give during NPO status — this requires nursing or prescriber clarification. Distractor A violates the
NPO order and assumes the multivitamin can be crushed and tube-administered without authorization.
Distractor C assumes incorrectly — most NPO orders include medication restrictions unless explicitly
stated otherwise. Distractor D is inappropriate because multivitamins are not formulated for sublingual
absorption and would be ineffective. Clinical Pearl: "NPO except medications" must be explicitly
ordered — never assume oral meds are permitted during NPO status without written clarification.
ACTUAL EXAM 2026/2027 | Complete Exam-
Style Questions | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Medication Administration (Questions 1-25)
Q1: During a morning med pass, the QMA notices that the blister card for a resident has "Metoprolol 25
mg" but the MAR (Medication Administration Record) shows "Metoprolol 50 mg." The QMA has not yet
removed the medication. What is the MOST appropriate action?
A. Administer the 25 mg and document it, then notify the nurse after the med pass
B. Crush the 25 mg tablet and give it to avoid missing the dose entirely
C. Hold the medication, notify the supervising nurse immediately, and do not administer until the
discrepancy is resolved [CORRECT]
D. Give 25 mg now and offer an extra 25 mg from a different resident's cart later
Correct Answer: C
Rationale: The correct answer is C because the Six Rights include "right dose" and "right medication."
Any discrepancy between the MAR and medication supply requires stopping the med pass for that drug
and immediately notifying the supervising nurse — before administration. Distractor A is wrong because
administering an incorrect dose violates QMA scope and resident safety; documentation does not
retroactively fix the error. Distractor B is dangerous — crushing metoprolol (not safe) and ignoring the
dose mismatch. Distractor D is a medication error (taking from another resident) and potentially a
controlled substance violation if that other cart contains scheduled drugs. Clinical Pearl: QMAs are
never responsible for resolving order discrepancies — only for identifying them, holding, and reporting
up.
Q2: A resident is prescribed an enteric-coated aspirin 81 mg daily. The resident refuses to swallow the
tablet whole and requests that it be crushed and mixed with applesauce. What should the QMA do?
A. Crush the tablet and mix with applesauce as requested
B. Crush the tablet only if the family consents
C. Do not crush the tablet; notify the supervising nurse and document the resident's refusal [CORRECT]
D. Hide the crushed tablet in ice cream without telling the resident
,Correct Answer: C
Rationale: The correct answer is C because enteric-coated medications are designed to bypass gastric
acid and dissolve in the intestines; crushing destroys the protective coating, causing gastric irritation and
altering drug absorption. QMAs cannot alter medication formulation without a nurse or prescriber
order. Distractor A violates medication safety — crushing an enteric-coated tablet is never appropriate.
Distractor B incorrectly delegates clinical decision-making to family members rather than nursing staff.
Distractor D constitutes deception in medication administration, which violates resident rights and
informed consent principles. Clinical Pearl: "Do not crush" medications include enteric-coated,
sustained-release, sublingual, and certain chemotherapy drugs — always verify before crushing.
Q3: The QMA is preparing to administer a sublingual nitroglycerin tablet to a resident experiencing chest
pain. The QMA should instruct the resident to:
A. Swallow the tablet with a full glass of water
B. Chew the tablet thoroughly before swallowing
C. Place the tablet under the tongue and allow it to dissolve completely without swallowing [CORRECT]
D. Crush the tablet and mix with water
Correct Answer: C
Rationale: The correct answer is C because sublingual nitroglycerin is absorbed through the rich vascular
network under the tongue, bypassing first-pass hepatic metabolism and providing rapid onset of action
(1-3 minutes). Swallowing the tablet would delay absorption and reduce effectiveness. Distractor A
destroys the sublingual route advantage and delays therapeutic effect. Distractor B (chewing) is
incorrect for sublingual tablets — chewing may alter absorption kinetics. Distractor D is never
appropriate for sublingual medications and would render the drug ineffective. Clinical Pearl: Sublingual
nitroglycerin administration requires the resident to avoid eating, drinking, or smoking for 5 minutes
before and after administration to ensure proper absorption.
Q4: A resident's MAR indicates "Furosemide 40 mg PO daily at 0800." The QMA checks the medication
cart and finds only Furosemide 20 mg tablets. What is the correct action?
A. Give two 20 mg tablets to equal the ordered 40 mg dose
B. Hold the medication and notify the supervising nurse immediately [CORRECT]
C. Give one 20 mg tablet and document a partial dose
D. Borrow a 40 mg tablet from another resident's supply
Correct Answer: B
Rationale: The correct answer is B because QMAs cannot independently determine equivalent dosing or
substitute tablet quantities without nursing verification. The MAR specifies 40 mg, and only 20 mg
tablets are available — this is a supply discrepancy that requires nurse intervention to verify whether
,two 20 mg tablets are appropriate or if the order needs clarification. Distractor A assumes equivalence
without authorization and bypasses the verification process. Distractor C administers a subtherapeutic
dose without authorization. Distractor D violates medication security, resident privacy, and controlled
substance regulations. Clinical Pearl: "Give two of X to equal Y" seems logical but requires nurse
verification — tablet splitting, doubling, or substitution always needs RN/LPN approval.
Q5: The QMA is transcribing a new physician order: "Warfarin 5 mg PO daily, hold if INR > 4.0." The QMA
should:
A. Transcribe the order as written and place a reminder note in the MAR
B. Transcribe the order and notify the nurse that a hold parameter is present [CORRECT]
C. Ignore the hold parameter and give the medication daily regardless of INR
D. Refuse to transcribe the order because QMAs cannot administer anticoagulants
Correct Answer: B
Rationale: The correct answer is B because QMAs can administer oral anticoagulants under supervision,
but hold parameters (such as INR > 4.0) require nursing oversight for lab value verification and clinical
decision-making. The QMA must transcribe the order accurately and immediately notify the nurse that a
hold parameter exists. Distractor A fails to alert nursing to the need for lab monitoring and hold protocol
activation. Distractor C ignores a critical safety parameter and could cause bleeding complications.
Distractor D is incorrect — QMA scope typically includes oral anticoagulant administration with proper
training and supervision. Clinical Pearl: Any order with hold parameters, sliding scales, or lab-dependent
dosing requires immediate nursing notification to ensure monitoring protocols are established.
Q6: A resident is prescribed an ophthalmic eye drop (Timolol 0.5%) one drop in the right eye twice daily.
The QMA should:
A. Instill the drop onto the center of the cornea
B. Instill the drop into the conjunctival sac (lower eyelid pocket) and instruct the resident to close the
eye gently for 1-2 minutes [CORRECT]
C. Instill two drops to ensure adequate medication delivery
D. Touch the dropper tip to the eyelid to stabilize it
Correct Answer: B
Rationale: The correct answer is B because ophthalmic drops are instilled into the conjunctival sac (the
pocket formed by pulling down the lower eyelid) to maximize contact with the ocular surface and
minimize systemic absorption. Gentle eye closure for 1-2 minutes with nasolacrimal duct pressure
prevents drainage into the nasal mucosa. Distractor A risks corneal irritation and reflex tearing that
washes out the medication. Distractor C delivers excess medication that increases systemic absorption
and waste. Distractor D contaminates the dropper tip and risks cross-contamination between residents.
, Clinical Pearl: When administering multiple eye drops, wait 5 minutes between medications to prevent
washout; always administer drops before ointments.
Q7: The QMA is preparing an inhaled bronchodilator (albuterol) via metered-dose inhaler (MDI) with a
spacer. The correct technique includes:
A. Shaking the canister, attaching the spacer, pressing the canister once, and having the resident
breathe normally through the spacer [CORRECT]
B. Pressing the canister multiple times rapidly to ensure adequate dose delivery
C. Having the resident exhale into the spacer before actuation
D. Removing the spacer because it reduces medication delivery
Correct Answer: A
Rationale: The correct answer is A because the MDI with spacer technique requires shaking the canister
to mix the medication, attaching the spacer to slow particle velocity and improve lung deposition,
actuating one puff into the spacer, and having the resident breathe slowly and deeply through the
mouthpiece. Distractor B causes medication overdose and increased side effects (tachycardia, tremors).
Distractor C forces exhaled air (with CO2 and moisture) into the spacer, potentially affecting medication
stability. Distractor D contradicts evidence-based practice — spacers significantly improve MDI delivery
to the lungs and reduce oropharyngeal deposition. Clinical Pearl: Wait 30-60 seconds between puffs
when multiple actuations are ordered to allow airway receptors to respond and improve drug
distribution.
Q8: A resident's MAR shows "Multivitamin 1 tablet PO daily" but the resident is currently NPO (nothing
by mouth) for a scheduled procedure. What should the QMA do?
A. Crush the multivitamin and administer via feeding tube
B. Hold the medication and notify the supervising nurse [CORRECT]
C. Give the tablet with a small sip of water, assuming the NPO order doesn't apply to medications
D. Place the tablet under the resident's tongue for sublingual absorption
Correct Answer: B
Rationale: The correct answer is B because NPO status applies to all oral medications unless specifically
exempted by the physician or nurse. QMAs cannot independently determine which medications are safe
to give during NPO status — this requires nursing or prescriber clarification. Distractor A violates the
NPO order and assumes the multivitamin can be crushed and tube-administered without authorization.
Distractor C assumes incorrectly — most NPO orders include medication restrictions unless explicitly
stated otherwise. Distractor D is inappropriate because multivitamins are not formulated for sublingual
absorption and would be ineffective. Clinical Pearl: "NPO except medications" must be explicitly
ordered — never assume oral meds are permitted during NPO status without written clarification.
