CMA Final Quetions

What does CNS stand for?

Central Nervous System

What information should the CMA report? When and how should it be reported?

Changes in conditions, abnormal vitals or assessment findings, medication refusals. Report promptly, thoroughly, and accurately, document time and date. Only document what you observed and did. Do not record for another person. Use exact wording from patient when possible. Be descriptive.

What is a medical record? Is a doctor's order part of a permanent record?

Chart or clinical record that includes a written account of a client's condition, care plan, and their response to treatment and care. Yes, the order is part of the permanent record.

What factors influence topical medication absorption?

Decrease absorption, drier skin, wrinkled skin, decreased amount of hair follicles, and decreased amount of blood flow to the tissues.

Define ischemia

Decreased blood supply to a body part

Identify what you will do if a patient refuses already prepared medications?

Dispose of per facility policy.

Who prescribes medications?

Doctors, PAs, Nurse Practitioners, Dentists.

List examples of adrenergic agents

Dopamine, epinephrine, norepinephrine

In which order do you give eye medications?

Drops before ointment.

Who enforces the Comprehensive Drug Abuse Prevention & Control Act? What is the other name for this and what are the major previsions?

Drug Enforcement Agency. (DEA) Controlled Substance Act. Classifies drugs into 5 schedules based on their potential for abuse. Schedule I is illegal drugs and Schedule II are also called controlled. Schedule V you do not need a prescription for.

How are medications sorted in assisted living facilities? Where are medications stored if the patient is self-administering? When should the CMA leave medications with the client?

Drug organizers. Locked container in individuals bedroom. Never.

What is euphoria?

Exaggerated feeling of well-being

List the proper steps for administering eye drops and eye ointments.

Explain the procedure, explain that it will cause blurriness/stinging, place in correct position, clean the eye before applying (inner to outer), waste a small amount of the ointment and apply pressure on the inner canthus. Remember to wash hands and apply gloves. Wait 1 min between drops of the same med and 3 mins if a different med.

What are the proper steps for administering nasal sprays? Nasal drops?

Explain the procedure, provide privacy, have patient blow nose before (not after), practice good hand hygiene, place in proper positioning (spray, sitting, drops, supine) have them hold opposite nostril, insert tip into nostril, administer medication when patient takes breath from the nose, wipe the tip between nostrils and when done administering.

List the proper steps for administering a multi-dose inhaler (MDI).

Explain the procedure, shake inhaler, have the client hold their breath for 10 seconds and then exhale slowly through the mouth, depress on inhalation, wait 1 to 3 minutes between puffs- do not give immediately after each other, and rinse mouth and inhaler with water after.

What are the proper techniques to weigh a person?

Explain the procedure, weigh the same time everyday, usually before breakfast, zero-balance the scale, have the patient void before, do not have the patient wear shoes or a lot of clothes, use the same scale.

Define Triglycerides

Fatty compounds from animal or vegetable fats

Who enforces the Federal Food Drug & Cosmetic Act? What are the major provisions of this act?

Food and Drug Administration (FDA). Ensure manufacturers meet labeling requirements, determine the safety and effectiveness of drugs, require that advertising standards are met. Identifies 3 legal classifications of medications.

Generic versus Trade name.

Generic: drugs common name, based off of the main active chemical, longer, harder to pronounce, starts with a lower case letter. Trade name: brand name, given by the manufacture, shorter, easier to pronounce, starts with a capital letter.

What nursing precaution is used to prevent GI upset/stomach irritation?

Give medications with food or milk.

What are the proper techniques to obtain an oral temperature?

Have the patient moisten lips, base thermometer at base of tongue to one side, have patient close lips around probe to hold into place, remind the patient not to talk or bite the probe, make sure the patient has not had anything to eat or drink or smoked within 15 to 20 minutes.

What should the CMA do if the patient is started on a new medication and develops a rash?

Hold the medication and tell the nurse.

What is it called when your body is in a constant state of equilibrium?

Homeostasis

Define hypo/hyperglycemia. Include signs and symptoms of each.

Hypoglycemia: low blood sugar Hyperglycemia: high blood sugar. Extreme tiredness, drowsiness, extreme thirst

What can you not do as a CMA?

IM/IV/Sub-Q. Can do Sub-Q insulin if trained and reevaluated every 6 hours.

What does the CMA need to do before administering medications?

Immediately identify the patient when at the bedside, place the patient in the correct position, if giving oral medications give the patient a drink first.

What is the goal of medication therapy for Parkinson's disease?

Increase the amount of dopamine available to brain cells to lessen symptoms (stiffness)

What do you do if you need to leave the medication cart in the hallway?

Lock the cart.

What does MAR stand for?

Medication Administration Record

What is the process of drug metabolism and excretion?

Metabolism: process in which the body inactivates the drug. Majority of metabolism takes place in the liver. Excretion: Elimination of drugs from the body. Majority of excretion occurs through urine and feces.

What nursing precautions do you use when giving a powder form of bile acid-binding resins?

Mix the powder with 2-6 ounces of water

What does the CMA need to monitor when administering Tegretol (carbazepine) and Topamax (topiratmate)?

Monitor the patient's weight.

What special considerations need to be in place with controlled substances?

Must be stored under 2 locks with 2 different keys and counted every 8 hours by 2 people. There are only 2 times a person can have a controlled substance in their possession (When administering and if they have an active prescription). Always dispose of a controlled substance with a witness.

What are adrenergic fibers?

Nerve endings that release norepinephrine

How many MLs in a tsp? TBSP?

5 MLs=1 tsp 15MLs=1 tbsp

How long does the patient remain in the proper position following nasal drops?

5 minutes

What is a drug blood level? If a client has kidney and/or liver disease, you would see medication levels in the blood to be? Should medication doses be increased or decreased? What should the CMA do if a client has questions regarding why medication doses were changed after a drug blood level?

A blood test used to determine the amount of drug in a person's blood. Increased. Decreased. Refer the patient to the nurse.

What is a hormone?

A chemical substance secreted by the endocrine glands into the blood stream.

What classification of anti-lipemic drugs is the strongest?

Statin

What does the CMA need to do following medication administration?

Stay with the client, make sure that the patient swallowed-do mouth checks or engage the client in a conversation. Document immediately after giving medications.

How is insulin administered?

Subcutaneous and intravenously

Identify subjective versus objective data.

Subjective: symptoms (reported) pain. Objective: signs (observed) dry skin.

Define hemoglobin.

Substance in a red blood cell that carries oxygen and gives blood its color.

What is a seizure?

Sudden tremor of muscle groups

What should the CMA do if a patient is having a new symptom of trouble swallowing? What if the symptom is not new?

Tell the nurse. Make sure that the patient is sitting up right, offer a straw vs. a cup, offer choices, give one pill at a time, go slowly, place at the back of the tongue, can crush and/or mix with applesauce with doctor order and permission of nurse.

How does a healthcare professional maintain professional boundaries? What is invasion of privacy?

The CMAs action must help the client and meet their needs, not yours. Violating a patients rights by making their name, photo, or private information available to the public without consent.

Define Diabetic

The body cannot produce or use insulin properly

Identify the cerebral cortex.

The outside of the cerebrum. Responsible for the highest functions of the brain.

What happens when a person is dependent on a medication? What types of dependency can schedule II medications cause?

The patient is addicted. Withdrawal symptoms are likely. Can be physical and psychological. Physical and psychological.

Who can receive oral medications?

The patient who is alert, sitting up, and able to swallow.

Identify factors that affect drug absorption.

The route in which medications are given, how well the drug is dissolved. Gastric pH, gastric emptying, motility of the GI tract, blood flow. Dry, wrinkled skin, decreased amount of hair follicles, and decreased blood flow to tissues (decreased cardiac output) decrease topical drug absorption.

Define delegate. What can nurses delegate to the CMA? What can they not delelgate? What should the CMA do if they are not comfortable completing the delegated task?

To authorize another person to perform a nursing task in specific situations. Anything within the CMAs scope of practice. Nurses cannot delegate nursing judgement. Talk to the nurse. The CMA has the right to refuse a task.

Why do you apply pressure to the inner canthus following the administration of an eye medication?

To keep the action localized.

Define hyperlipidemia

Too many fats in the blood (high cholesterol)

T or F: QD, OU, OS, OD are unapproved abbreviations. What do you do if you see an unapproved abbreviation on the MAR?

True. Notify the nurse.

Define anxiety

Uneasy feeling in response to stress

Explain how to properly document and correct errors.

Use blue/black ink, do not erase, do not use whiteout, single-strike an error, initial and date the error, document pertinent information, accurately, and thoroughly.

What does tolerance mean?

When a patient needs a higher dose to produce the same effects that lower doses once produced.

What is tolerance?

When a patient needs a higher dose to produce the same effects that lower doses once produced.

How are succinimides administered? (Antiepileptic)

With food

WHat is dysrhythmia

An abnormal heart rhythm

What is an artery? Vein?

Artery: carries blood AWAY from the heart. Vein: carries blood BACK to the heart.

What does the CMA do if they are unsure of a medication order?

Ask the nurse.

Who should the CMA address any issues or concerns with?

Ask the nurse.

When should the first dose of anti-seizure medications (i.e. Neurontin) be administered?

At bedtime

Know acceptable abbreviations. QID, TID, BID, P.C., A.C., H.S., P.O.

QID: 4 times daily. TID: 3 times daily. BID: 2 times daily. P.C.: After Meals. A.C.: Before meals. H.S.: Hour of sleep/bedtime. P.O.: By mouth.

List proper steps for administering suppository medications (rectal and vaginal)

Rectal: Provide privacy, use good hand hygiene, place the patient on the left side, use a lubricant, place the supp in with the pointed part first and point to the spine, Do not leave in feces, supps are effective within 20 minutes. Vaginal: Provide privacy, use good hand hygiene, place the patient in the lithotomy position, use applicator provided, have patient remain supine with hips elevated 5 to 10 minutes after.

Why do we give flonase (Nasacort)?

Reduce nasal inflammation

How long do you keep a patient in the correct position following ear drops?

Remain in side-lying position at least 5-10 minutes.

Identify common psychotic disorders.

Schizophrenia (most common)

Define ointment

Semi-solid preparation containing drugs in an oily base.

Identify the difference between a side effect and a desired effect.

Side effect: Unintended reaction when given at a normal dose. Desired Effect: expected response, intended effect.

After a person receives insulin you as a CMA monitor for?

Signs and symptoms of hypoglycemia

Single Order Stat Order Standing Order PRN Order

Single: Give once only Stat: Immediately Standing: For certain number of doses/days PRN: As needed.

What is an opiate?

A drug that contains opium

Define antagonist

A drug that exerts an opposite action to that of another drug

Define advance directives.

A legal document describing a person's wishes regarding their health care when that person is not able to make their own decisions.

Define psychosis

A state of severe mental impairment

What are the roles of the CMA and who supervises them?

Administer medications, supervise the self-administering client, observe and report signs and symptoms. Licensed Nurse.

Where is oxygen and carbon dioxide exchanged?

Between alveoli and capillaries.

Know buccal versus sublingual administration.

Buccal: between the cheek and molars. Sublingual: Under the tongue.

Explain what factors influence slow gastrointestinal absorption of medication in elderly.

Slower stomach emptying, slow GI motility, decreased blood flow to stomach and intestine, and decreased gastric acid secretions.

Where does the majority of food absorption take place?

Small intestines (jejunum, ileum)

Can the CMA crush medications?

Not without a doctor's order.

Identify the proper steps for applying a transdermal patch

Observe the 5 rights of safe medication pass, initial and date the new patch, remove the old patch before applying new, observe the area for irritation, clean and dry the skin, rotate application sites, may need to clip hair if patient is too hairy

Define cumulative effect.

Occurs when a drug accumulates in the body if the next dose is given before the previous dose is metabolized or excreted. Toxicity can occur.

What is a drug interaction? Why are the elderly at greatest risk for drug interactions?

Occurs when the action of a drug is altered by the action of another drug, interactions can increase or decrease the effectiveness of one or both drugs. Some are beneficial. Multiple chronic illnesses.

Define ocular and otic.

Ocular: Eye (also ophthalmic) Otic: Ear

What should the CMA do if a patient is refusing medications?

Offer choices, use a firm approach "I have your medications, would you like water or juice?" Reapproach, figure out why they are refusing, have a different CMA or nurse attempt, document and report.

Who can the CMA discuss client's medication orders with?

Only those pertinent to the client's care.

What are the 3 legal classifcations of medications?

Over-the-counter (OTC), Prescription, and Controlled.

What does OTC stand for? How is it different than a prescription medication?

Over-the-counter. You do not need a prescription to purchase OTC medications.

What route of medication administration can the CMA complete?

PO, topical, eye/ear drops/treatments, inhalers, nose drops/sprays, transdermal patches.

Identify how and when to properly document PRN medications.

PRN medications are documented immediately after giving in the progress note and the MAR. The CMA needs to chart what medication was given, at what time, what dose, and why. Effectiveness of the PRN needs to be documented 30 minutes to 1 hour after administration.

What tool is used to measure a patient's pain and what does it measure?

Pain rating scale used to measure the intensity of pain

Define standardized medication times and what daily means. What are the benefits of standardized medication times? What is the time frame the state of Iowa gives you to pass medications?

Patients are given medications on standardized schedule. Medication passes occur for the majority of the patients within a facility at the same time. Helps prevent drug errors and ensures that all medications are passed safely and on time. 1 hour before and after the stated due time. Due time is dependent on the facilities policies.

How many patient identifiers do you use and what can you use as identifiers.

Per facility policy. Always use 2 identifiers. Room numbers/bed numbers. Do NOT count. Name with DOB, ID band.

Identify the proper steps for administering ear drops.

Practice good hand hygiene, provide privacy, position on the side with affected ear up, clean ear with a wet washcloth to remove excessive ear wax (do not insert into canal), observe the area, report any concerns, for adults pull the ear up and back (age 2 and younger pull down and back), install the number of drops ordered (do not have to wait in between drops), can insert cotton ball for 15 minutes.

List the proper steps for applying powder and other topical medications

Practice good hand hygiene, wash and observe the area, report any concerns, do not sparkle the powder right on the client (use gloves or cloth), do not clip the hair, but apply topical meds in direction of hair growth, shake lotions if needed.

Why are topical medications used to debride a wound?

Prevent infection and promote healing.