ALF Medication Management Principles 2 — Questions and Answers
Question 1: A resident's medication label reads 'Take 1 tablet by mouth twice daily.' The resident asks the med aide to crush the tablet into applesauce. What must be verified FIRST?
- That the pharmacist or prescriber has confirmed the medication is safe to crush (Correct answer)
- That the resident signs a waiver accepting responsibility
- That the applesauce is sugar-free
- That a family member approves the change
Correct answer: That the pharmacist or prescriber has confirmed the medication is safe to crush
Some formulations, such as extended-release or enteric-coated tablets, must never be crushed, so pharmacist or prescriber confirmation is required first.
Question 2: Which of the following is an example of a medication error that must be documented and reported in an assisted living facility?
- A resident refuses a scheduled dose and the refusal is charted
- A dose is given two hours after the scheduled time, outside the facility's allowable window (Correct answer)
- A PRN medication is not given because the resident had no symptoms
- A medication is held per a prescriber's written order
Correct answer: A dose is given two hours after the scheduled time, outside the facility's allowable window
A dose administered outside the facility's acceptable time window is a wrong-time error requiring documentation and reporting.
Question 3: Under most state regulations, who may perform the initial assessment to determine whether a resident can safely self-administer medications?
- The resident's family
- Any direct care staff member
- A licensed health care professional, such as a nurse or physician (Correct answer)
- The facility's dietary manager
Correct answer: A licensed health care professional, such as a nurse or physician
Determining self-administration capability is a clinical judgment that must be made by a licensed health care professional.
Question 4: A medication administration record (MAR) shows initials in a time slot but the medication cart count reveals the dose was never removed. This discrepancy is BEST described as:
- A documentation error suggesting the dose was charted but not given (Correct answer)
- An acceptable variance requiring no follow-up
- Proof the resident refused the medication
- Evidence the pharmacy shorted the delivery
Correct answer: A documentation error suggesting the dose was charted but not given
Initialing the MAR without administering the dose is a documentation/omission discrepancy that must be investigated.
Question 5: Which practice BEST reduces the risk of medication diversion of controlled substances in an assisted living facility?
- Storing controlled substances with regular medications to avoid drawing attention
- Shift-to-shift counts of controlled substances by two staff members with documented reconciliation (Correct answer)
- Allowing only the administrator to handle narcotics
- Keeping controlled substance records for 30 days only
Correct answer: Shift-to-shift counts of controlled substances by two staff members with documented reconciliation
Two-person shift counts with documented reconciliation create accountability that deters and detects diversion.
Question 6: A resident returns from a hospital stay with a new medication list. What medication management process must occur before administration resumes?
- Medication reconciliation comparing the new orders against the current MAR (Correct answer)
- Disposal of all medications the resident used before hospitalization
- A 72-hour hold on all medications
- Approval by the resident council
Correct answer: Medication reconciliation comparing the new orders against the current MAR
Reconciliation identifies discrepancies between hospital discharge orders and existing facility orders before dosing resumes.
Question 7: Which storage practice violates standard medication management requirements in assisted living?
- Refrigerated medications kept in a locked, dedicated medication refrigerator
- Topical creams stored separately from oral medications
- A medication cart left unlocked and unattended in the hallway during rounds (Correct answer)
- Medications labeled with the resident's name and prescriber's directions
Correct answer: A medication cart left unlocked and unattended in the hallway during rounds
Medication carts must be locked whenever they are unattended to prevent unauthorized access.
ALF Medication Management Principles 2
A resident's medication label reads 'Take 1 tablet by mouth twice daily.' The resident asks the med aide to crush the tablet into applesauce.
What must be verified FIRST?