VIRGINIA MEDICATION AIDE PREP EXAM
2025/2026
1. A patient with chronic kidney disease (eGFR 25 mL/min) is prescribed enoxaparin 1 mg/kg
subcutaneously twice daily for DVT prophylaxis. The medication aide notes the patient also takes
warfarin 2 mg daily. Which action is most appropriate?
A. Administer enoxaparin as ordered, monitor for bleeding.
B. Hold enoxaparin and notify the provider due to elevated bleeding risk.
C. Administer enoxaparin but reduce the dose by 50%.
D. Administer enoxaparin and warfarin together to minimize injections.
Answer: B
Rationale: Enoxaparin is renally cleared and accumulates in CKD, increasing bleeding risk. Concurrent
warfarin further elevates risk. The aide must hold enoxaparin and notify the provider for dose
adjustment or alternative therapy. Option A ignores accumulation; C is beyond scope; D increases risk.
2. A medication aide is preparing to administer an oral liquid medication. The label reads '125
mg/5 mL'. The prescribed dose is 200 mg. Using a syringe calibrated in 0.1 mL increments, what is
the correct volume to administer?
A. 8.0 mL
B. 8.5 mL
C. 7.5 mL
D. 9.0 mL
Answer: A
Rationale: Dose: 200 mg / (125 mg/5 mL) = 200/125 * 5 = 1.6 * 5 = 8 mL. The syringe can measure 8.0
mL precisely. Option B (8.5 mL) overestimates; C (7.5 mL) underestimates; D (9.0 mL) is incorrect.
3. A medication aide discovers that a colleague administered a medication to the wrong patient.
The colleague states the patient was not harmed and asks the aide to not report the error. What is
the aide's best action?
A. Agree not to report to maintain team trust.
B. Report the error to the supervisor immediately.
C. Document the error in the patient's chart but not report it.
D. Advise the colleague to self-report and wait 24 hours.
Answer: B
Rationale: Medication errors must be reported immediately regardless of harm to ensure patient safety
and system improvement. Failure to report violates legal and ethical obligations. Option A is unethical;
C is incomplete; D delays necessary action.
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, 4. A patient develops a pruritic rash after starting a new antibiotic. The medication aide suspects
an allergic reaction. Which of the following is the most appropriate immediate action?
A. Administer diphenhydramine and continue the antibiotic.
B. Hold the antibiotic and notify the prescriber.
C. Apply topical hydrocortisone and document the rash.
D. Discontinue the antibiotic and start an alternative.
Answer: B
Rationale: A new rash after starting a medication may indicate an allergic reaction. The aide should hold
the antibiotic and notify the prescriber for evaluation. Option A is beyond scope and may mask
symptoms; C ignores potential severity; D is outside aide's scope.
5. A patient is prescribed metoprolol succinate 50 mg orally once daily. The pharmacy delivers
metoprolol tartrate 50 mg tablets. Which action is correct?
A. Administer the tartrate as a one-time substitution.
B. Hold the medication and contact the prescriber.
C. Administer the tartrate but double the dose.
D. Return the tartrate and request the correct formulation.
Answer: B
Rationale: Metoprolol succinate (extended-release) and tartrate (immediate-release) are not
interchangeable due to different pharmacokinetics. The aide must hold and notify the prescriber. Option
A is unsafe; C is dangerous; D is correct but requires prescriber order first.
6. A patient receiving digoxin has a heart rate of 52 bpm. The medication aide reviews the
medication administration record. What is the priority action?
A. Administer digoxin as scheduled.
B. Check the patient's potassium level.
C. Hold digoxin and assess for toxicity symptoms.
D. Administer half the dose.
Answer: C
Rationale: Bradycardia (HR <60 bpm) is a sign of digoxin toxicity. The aide should hold the dose, assess
for other toxicity signs (nausea, visual changes), and notify the nurse/prescriber. Option A risks
worsening toxicity; B is relevant but not immediate; D is inappropriate.
7. A patient is receiving heparin 5000 units subcutaneously every 8 hours. Which laboratory value
is most important for the medication aide to review before administration?
A. Serum creatinine
B. Platelet count
C. Hemoglobin
D. International normalized ratio (INR)
Answer: B
Rationale: Heparin can cause heparin-induced thrombocytopenia (HIT), a life-threatening drop in
platelets. Monitoring platelet count is essential. Creatinine is for renal function; hemoglobin for
bleeding; INR for warfarin, not heparin.
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2025/2026
1. A patient with chronic kidney disease (eGFR 25 mL/min) is prescribed enoxaparin 1 mg/kg
subcutaneously twice daily for DVT prophylaxis. The medication aide notes the patient also takes
warfarin 2 mg daily. Which action is most appropriate?
A. Administer enoxaparin as ordered, monitor for bleeding.
B. Hold enoxaparin and notify the provider due to elevated bleeding risk.
C. Administer enoxaparin but reduce the dose by 50%.
D. Administer enoxaparin and warfarin together to minimize injections.
Answer: B
Rationale: Enoxaparin is renally cleared and accumulates in CKD, increasing bleeding risk. Concurrent
warfarin further elevates risk. The aide must hold enoxaparin and notify the provider for dose
adjustment or alternative therapy. Option A ignores accumulation; C is beyond scope; D increases risk.
2. A medication aide is preparing to administer an oral liquid medication. The label reads '125
mg/5 mL'. The prescribed dose is 200 mg. Using a syringe calibrated in 0.1 mL increments, what is
the correct volume to administer?
A. 8.0 mL
B. 8.5 mL
C. 7.5 mL
D. 9.0 mL
Answer: A
Rationale: Dose: 200 mg / (125 mg/5 mL) = 200/125 * 5 = 1.6 * 5 = 8 mL. The syringe can measure 8.0
mL precisely. Option B (8.5 mL) overestimates; C (7.5 mL) underestimates; D (9.0 mL) is incorrect.
3. A medication aide discovers that a colleague administered a medication to the wrong patient.
The colleague states the patient was not harmed and asks the aide to not report the error. What is
the aide's best action?
A. Agree not to report to maintain team trust.
B. Report the error to the supervisor immediately.
C. Document the error in the patient's chart but not report it.
D. Advise the colleague to self-report and wait 24 hours.
Answer: B
Rationale: Medication errors must be reported immediately regardless of harm to ensure patient safety
and system improvement. Failure to report violates legal and ethical obligations. Option A is unethical;
C is incomplete; D delays necessary action.
Page 1
, 4. A patient develops a pruritic rash after starting a new antibiotic. The medication aide suspects
an allergic reaction. Which of the following is the most appropriate immediate action?
A. Administer diphenhydramine and continue the antibiotic.
B. Hold the antibiotic and notify the prescriber.
C. Apply topical hydrocortisone and document the rash.
D. Discontinue the antibiotic and start an alternative.
Answer: B
Rationale: A new rash after starting a medication may indicate an allergic reaction. The aide should hold
the antibiotic and notify the prescriber for evaluation. Option A is beyond scope and may mask
symptoms; C ignores potential severity; D is outside aide's scope.
5. A patient is prescribed metoprolol succinate 50 mg orally once daily. The pharmacy delivers
metoprolol tartrate 50 mg tablets. Which action is correct?
A. Administer the tartrate as a one-time substitution.
B. Hold the medication and contact the prescriber.
C. Administer the tartrate but double the dose.
D. Return the tartrate and request the correct formulation.
Answer: B
Rationale: Metoprolol succinate (extended-release) and tartrate (immediate-release) are not
interchangeable due to different pharmacokinetics. The aide must hold and notify the prescriber. Option
A is unsafe; C is dangerous; D is correct but requires prescriber order first.
6. A patient receiving digoxin has a heart rate of 52 bpm. The medication aide reviews the
medication administration record. What is the priority action?
A. Administer digoxin as scheduled.
B. Check the patient's potassium level.
C. Hold digoxin and assess for toxicity symptoms.
D. Administer half the dose.
Answer: C
Rationale: Bradycardia (HR <60 bpm) is a sign of digoxin toxicity. The aide should hold the dose, assess
for other toxicity signs (nausea, visual changes), and notify the nurse/prescriber. Option A risks
worsening toxicity; B is relevant but not immediate; D is inappropriate.
7. A patient is receiving heparin 5000 units subcutaneously every 8 hours. Which laboratory value
is most important for the medication aide to review before administration?
A. Serum creatinine
B. Platelet count
C. Hemoglobin
D. International normalized ratio (INR)
Answer: B
Rationale: Heparin can cause heparin-induced thrombocytopenia (HIT), a life-threatening drop in
platelets. Monitoring platelet count is essential. Creatinine is for renal function; hemoglobin for
bleeding; INR for warfarin, not heparin.
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