,1. A resident with type 1 diabetes has a blood glucose level of 58 mg/dL and is alert and oriented. Which action
should the QMA take first?
A. Administer 15 grams of fast-acting carbohydrate
B. Administer 1 mg glucagon intramuscularly
C. Call 911 immediately
D. Hold the next dose of insulin
Correct Answer: A
Rationale: For a conscious resident with hypoglycemia, the QMA should administer 15 grams of fast-acting
carbohydrate (e.g., glucose tablets, juice). Glucagon is for unconscious residents. Calling 911 is not the first step.
2. Which insulin is classified as a rapid-acting analogue and should be administered 15 minutes before a meal?
A. Insulin lispro (Humalog)
B. Regular insulin (Humulin R)
C. NPH insulin (Humulin N)
D. Insulin glargine (Lantus)
Correct Answer: A
Rationale: Insulin lispro is a rapid-acting analogue with onset in 15 minutes. Regular insulin is short-acting (onset 30-60
min). NPH is intermediate, and glargine is long-acting.
3. A resident receives 10 units of NPH insulin at 0800. When is the peak action most likely to occur?
A. 0900–1000
B. 1200–1600
C. 1700–2000
D. 2000–2400
Correct Answer: B
Rationale: NPH insulin peaks in 4–8 hours, so administration at 0800 would peak around 1200–1600. This is when the
resident is at highest risk for hypoglycemia.
4. Which site is preferred for subcutaneous insulin injection to ensure consistent absorption?
A. Abdomen
B. Thigh
C. Upper arm
D. Buttocks
Correct Answer: A
Rationale: The abdomen provides the most consistent absorption due to its relatively stable blood flow. Rotation within
the same region is recommended to avoid lipodystrophy.
,5. The QMA is preparing to administer insulin glargine (Lantus). Which statement about this insulin is correct?
A. It should be mixed with NPH insulin in the same syringe
B. It should be given once daily at the same time each day
C. It can be given intravenously
D. It has a peak action at 4–6 hours
Correct Answer: B
Rationale: Insulin glargine is a long-acting basal insulin given once daily at the same time. It should not be mixed with
other insulins and is not given IV. It has no pronounced peak.
6. A resident's blood glucose is 350 mg/dL with positive urine ketones. The resident has type 1 diabetes and is
experiencing nausea and vomiting. What is the QMA's priority action?
A. Administer the scheduled dose of rapid-acting insulin
B. Encourage the resident to drink fluids
C. Notify the licensed nurse immediately
D. Check blood glucose again in 1 hour
Correct Answer: C
Rationale: Hyperglycemia with ketones and vomiting suggests diabetic ketoacidosis (DKA), a medical emergency. The
licensed nurse should be notified immediately for further evaluation and treatment.
7. When drawing up a mixture of regular and NPH insulin, what is the correct order of drawing?
A. Draw NPH first, then regular
B. Draw regular first, then NPH
C. Draw both insulins simultaneously
D. The order does not matter
Correct Answer: B
Rationale: "Clear to cloudy" – draw regular insulin (clear) first to prevent contamination of the regular vial with NPH.
Then draw NPH (cloudy).
8. Which of the following is a symptom of hypoglycemia that the QMA should watch for?
A. Polyuria
B. Polydipsia
C. Diaphoresis
D. Fruity breath odor
Correct Answer: C
Rationale: Diaphoresis (sweating) is an adrenergic symptom of hypoglycemia. Polyuria, polydipsia, and fruity breath
are signs of hyperglycemia or DKA.
9. How should the QMA store unopened vials of insulin?
A. In the freezer
B. At room temperature
C. In the refrigerator (36°F–46°F)
D. In direct sunlight
, Correct Answer: C
Rationale: Unopened insulin vials should be stored in the refrigerator at 36°F–46°F. Once opened, they can be kept at
room temperature for up to 28 days.
10. A resident receives 5 units of insulin lispro at 0800. At which time should the QMA ensure the resident's meal
is available?
A. Immediately (within 15 minutes)
B. 30 minutes after injection
C. 1 hour after injection
D. 2 hours after injection
Correct Answer: A
Rationale: Insulin lispro is rapid-acting with onset in about 15 minutes. The resident should eat within 15 minutes to
prevent hypoglycemia.
11. Which documentation is required after administering insulin to a resident?
A. Blood glucose level, insulin type and dose, injection site
B. Only the blood glucose level
C. Only the insulin dose administered
D. Time of injection and type of needle used
Correct Answer: A
Rationale: Documentation must include blood glucose level, type and dose of insulin, injection site, and any resident
response. This ensures continuity of care and safety.
12. A resident has a blood glucose of 45 mg/dL and is unresponsive. What should the QMA do immediately?
A. Administer 15 grams of glucose gel buccally
B. Administer 1 mg glucagon IM
C. Call 911 and wait for paramedics
D. Give 4 oz of orange juice
Correct Answer: B
Rationale: For an unresponsive resident with severe hypoglycemia, glucagon 1 mg IM is the appropriate treatment. Oral
carbohydrates cannot be given safely.
13. Which of the following insulins is a basal (long-acting) insulin that should not be mixed with any other insulin?
A. Insulin aspart (NovoLog)
B. Insulin detemir (Levemir)
C. Insulin glulisine (Apidra)
D. 70/30 NPH/regular mixture
Correct Answer: B
Rationale: Insulin detemir and glargine are long-acting basal insulins that should not be mixed in the same syringe. They
are given once daily.
should the QMA take first?
A. Administer 15 grams of fast-acting carbohydrate
B. Administer 1 mg glucagon intramuscularly
C. Call 911 immediately
D. Hold the next dose of insulin
Correct Answer: A
Rationale: For a conscious resident with hypoglycemia, the QMA should administer 15 grams of fast-acting
carbohydrate (e.g., glucose tablets, juice). Glucagon is for unconscious residents. Calling 911 is not the first step.
2. Which insulin is classified as a rapid-acting analogue and should be administered 15 minutes before a meal?
A. Insulin lispro (Humalog)
B. Regular insulin (Humulin R)
C. NPH insulin (Humulin N)
D. Insulin glargine (Lantus)
Correct Answer: A
Rationale: Insulin lispro is a rapid-acting analogue with onset in 15 minutes. Regular insulin is short-acting (onset 30-60
min). NPH is intermediate, and glargine is long-acting.
3. A resident receives 10 units of NPH insulin at 0800. When is the peak action most likely to occur?
A. 0900–1000
B. 1200–1600
C. 1700–2000
D. 2000–2400
Correct Answer: B
Rationale: NPH insulin peaks in 4–8 hours, so administration at 0800 would peak around 1200–1600. This is when the
resident is at highest risk for hypoglycemia.
4. Which site is preferred for subcutaneous insulin injection to ensure consistent absorption?
A. Abdomen
B. Thigh
C. Upper arm
D. Buttocks
Correct Answer: A
Rationale: The abdomen provides the most consistent absorption due to its relatively stable blood flow. Rotation within
the same region is recommended to avoid lipodystrophy.
,5. The QMA is preparing to administer insulin glargine (Lantus). Which statement about this insulin is correct?
A. It should be mixed with NPH insulin in the same syringe
B. It should be given once daily at the same time each day
C. It can be given intravenously
D. It has a peak action at 4–6 hours
Correct Answer: B
Rationale: Insulin glargine is a long-acting basal insulin given once daily at the same time. It should not be mixed with
other insulins and is not given IV. It has no pronounced peak.
6. A resident's blood glucose is 350 mg/dL with positive urine ketones. The resident has type 1 diabetes and is
experiencing nausea and vomiting. What is the QMA's priority action?
A. Administer the scheduled dose of rapid-acting insulin
B. Encourage the resident to drink fluids
C. Notify the licensed nurse immediately
D. Check blood glucose again in 1 hour
Correct Answer: C
Rationale: Hyperglycemia with ketones and vomiting suggests diabetic ketoacidosis (DKA), a medical emergency. The
licensed nurse should be notified immediately for further evaluation and treatment.
7. When drawing up a mixture of regular and NPH insulin, what is the correct order of drawing?
A. Draw NPH first, then regular
B. Draw regular first, then NPH
C. Draw both insulins simultaneously
D. The order does not matter
Correct Answer: B
Rationale: "Clear to cloudy" – draw regular insulin (clear) first to prevent contamination of the regular vial with NPH.
Then draw NPH (cloudy).
8. Which of the following is a symptom of hypoglycemia that the QMA should watch for?
A. Polyuria
B. Polydipsia
C. Diaphoresis
D. Fruity breath odor
Correct Answer: C
Rationale: Diaphoresis (sweating) is an adrenergic symptom of hypoglycemia. Polyuria, polydipsia, and fruity breath
are signs of hyperglycemia or DKA.
9. How should the QMA store unopened vials of insulin?
A. In the freezer
B. At room temperature
C. In the refrigerator (36°F–46°F)
D. In direct sunlight
, Correct Answer: C
Rationale: Unopened insulin vials should be stored in the refrigerator at 36°F–46°F. Once opened, they can be kept at
room temperature for up to 28 days.
10. A resident receives 5 units of insulin lispro at 0800. At which time should the QMA ensure the resident's meal
is available?
A. Immediately (within 15 minutes)
B. 30 minutes after injection
C. 1 hour after injection
D. 2 hours after injection
Correct Answer: A
Rationale: Insulin lispro is rapid-acting with onset in about 15 minutes. The resident should eat within 15 minutes to
prevent hypoglycemia.
11. Which documentation is required after administering insulin to a resident?
A. Blood glucose level, insulin type and dose, injection site
B. Only the blood glucose level
C. Only the insulin dose administered
D. Time of injection and type of needle used
Correct Answer: A
Rationale: Documentation must include blood glucose level, type and dose of insulin, injection site, and any resident
response. This ensures continuity of care and safety.
12. A resident has a blood glucose of 45 mg/dL and is unresponsive. What should the QMA do immediately?
A. Administer 15 grams of glucose gel buccally
B. Administer 1 mg glucagon IM
C. Call 911 and wait for paramedics
D. Give 4 oz of orange juice
Correct Answer: B
Rationale: For an unresponsive resident with severe hypoglycemia, glucagon 1 mg IM is the appropriate treatment. Oral
carbohydrates cannot be given safely.
13. Which of the following insulins is a basal (long-acting) insulin that should not be mixed with any other insulin?
A. Insulin aspart (NovoLog)
B. Insulin detemir (Levemir)
C. Insulin glulisine (Apidra)
D. 70/30 NPH/regular mixture
Correct Answer: B
Rationale: Insulin detemir and glargine are long-acting basal insulins that should not be mixed in the same syringe. They
are given once daily.
