CALA Medication Management & Pharmacy Services 2 — Questions and Answers
Question 1: An assisted living facility must store Schedule II controlled substances in a manner that meets DEA requirements. Which storage condition is mandatory?
- Refrigerated storage only
- Double-locked, substantially constructed cabinet (Correct answer)
- Locked medication cart accessible to all nurses
- Sealed plastic bag in the medication room
Correct answer: Double-locked, substantially constructed cabinet
The DEA requires Schedule II controlled substances to be stored in a securely locked, substantially constructed cabinet to prevent diversion and unauthorized access.
Question 2: Which federal agency regulates the registration of assisted living facilities that store and dispense controlled substances?
- Centers for Medicare & Medicaid Services (CMS)
- Drug Enforcement Administration (DEA) (Correct answer)
- Food and Drug Administration (FDA)
- State Board of Pharmacy
Correct answer: Drug Enforcement Administration (DEA)
The DEA enforces the Controlled Substances Act and requires facilities that handle controlled substances to register and comply with federal regulations.
Question 3: When a controlled substance is wasted or a partial dose is administered, best practice in assisted living requires:
- A single nurse to document the waste in the medication administration record
- Two authorized staff members to witness and co-sign the waste documentation (Correct answer)
- The administrator to be notified before disposal
- The unused portion to be returned to the pharmacy immediately
Correct answer: Two authorized staff members to witness and co-sign the waste documentation
Two-person witness and co-signature for controlled substance waste is the industry standard to prevent diversion and ensure accurate accountability records.
Question 4: A resident's physician calls to authorize a new medication verbally. What must assisted living staff do according to standard medication management protocols?
- Administer the medication immediately without any documentation
- Document the verbal order and obtain a written or electronic order within the timeframe specified by state regulations (Correct answer)
- Refuse to administer until a written order is received in advance
- Have a family member sign consent before documenting
Correct answer: Document the verbal order and obtain a written or electronic order within the timeframe specified by state regulations
Verbal orders must be documented immediately, signed by the receiving staff member, and followed up with a written or electronic order within the state-required timeframe.
Question 5: Which of the following best describes polypharmacy, a major concern for assisted living administrators managing resident health outcomes?
- The concurrent use of two or more medications from the same drug class
- The routine use of five or more medications simultaneously by one resident (Correct answer)
- The administration of any medication without a physician order
- The use of generic drugs instead of brand-name medications
Correct answer: The routine use of five or more medications simultaneously by one resident
Polypharmacy typically refers to the concurrent use of five or more medications, which increases the risk of drug interactions, adverse effects, and medication errors in older adults.
Question 6: An administrator discovers that a staff member has been diverting controlled substances from the facility. The correct immediate action is to:
- Handle the matter internally through progressive discipline only
- Remove the employee from access, report to law enforcement and the DEA, and cooperate fully with the investigation (Correct answer)
- Quietly terminate the employee to avoid negative publicity
- Wait for the next scheduled pharmacy audit to address the issue
Correct answer: Remove the employee from access, report to law enforcement and the DEA, and cooperate fully with the investigation
Controlled substance diversion is a federal crime requiring immediate reporting to law enforcement and the DEA, as well as removal of access to protect residents and the facility.
Question 7: What is the purpose of a medication administration record (MAR) in an assisted living facility?
- To serve as the billing document for pharmacy services
- To provide a legal, chronological documentation of each medication given, refused, or held for each resident (Correct answer)
- To track pharmacy inventory and reorder points
- To summarize quarterly pharmacist review findings
Correct answer: To provide a legal, chronological documentation of each medication given, refused, or held for each resident
The MAR is a legal document providing a complete, time-stamped record of medication administration, refusals, and holds, ensuring accountability and continuity of care.
CALA Medication Management & Pharmacy Services 2
An assisted living facility must store Schedule II controlled substances in a manner that meets DEA requirements.
Which storage condition is mandatory?