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MACE: Medication Administration, Observation & Reporting

This is the largest part of the MACE — about 60% of the exam. These questions cover the six rights, routes of administration, and what to observe and report to the nurse after giving a medication. Each one includes a full rationale.

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  • 💡 Key Takeaways — the one transferable rule per question
  • 🔍 Hint highlights — the decisive cue phrases in each stem
  • 📖 Full rationales — why every option is right or wrong

Every MACE question is written to the current exam outline for quick learning and a clear pass strategy.

Written and reviewed by the LexPort exam-prep team, led by our Founder & Exam-Prep Lead. LexPort builds certification practice questions — this is exam-preparation material, not medical advice. Last reviewed August 2026.

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Test yourself: 3 MACE practice questions

Tap an answer for instant feedback and the full rationale.

Question 1

A Medication Aide is preparing to administer ordered otic drops to a 78-year-old resident's right ear. Which technique is required for safe and effective administration?

▸ Why C is the answer

This is correct. For adults, the pinna is pulled up and back to straighten the ear canal. Pressing gently on the tragus helps move the medication down into the canal. Pulling the pinna down and back is the technique used for children under 3 years old, not adults. Additionally, cotton should not be packed firmly into the canal. Pulling straight back does not adequately straighten the adult ear canal, and sitting upright immediately will cause the drops to run out of the ear. Irrigating the ear after administering medication would wash the ordered medication away, rendering it ineffective.

Question 2

A Medication Aide is administering a routine bisacodyl rectal suppository to a resident. After positioning the resident in the left Sims' position and donning gloves, how should the aide insert the suppository?

▸ Why D is the answer

This is correct. The suppository must be inserted past the internal sphincter (about 1 inch in adults) and placed against the mucosal wall for proper absorption. Inserting the suppository into stool prevents it from melting and absorbing through the rectal tissue, making it ineffective. Inserting the suppository 3 inches is too deep and risks injury to the rectal tissue. Placing it just inside the external sphincter is too shallow; the suppository will likely be expelled immediately.

Question 3

Which statement describes the correct principle for administering a sublingual medication?

▸ Why A is the answer

This is correct. Sublingual medications are designed to be absorbed through the rich blood supply under the tongue and must dissolve completely on their own. Drinking water immediately after a sublingual medication washes it down the throat, preventing the intended absorption through the oral mucosa. Placing a tablet between the cheek and gum describes buccal administration, not sublingual. Chewing a sublingual tablet destroys the medication's delivery mechanism and causes it to be swallowed rather than absorbed correctly.

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Question 1

A resident is ordered to receive albuterol (a bronchodilator) and fluticasone (a corticosteroid) via metered-dose inhalers at 0800. How should the Medication Aide administer these medications?

  • A) Administer the fluticasone first, wait 1 minute, then administer the albuterol.
  • B) Administer either medication first, but have the resident rinse their mouth immediately before the second inhaler.
  • C) Administer the albuterol first, wait 1 to 5 minutes, then administer the fluticasone.✓
  • D) Administer both medications consecutively without a waiting period to ensure maximum lung absorption.
Show rationale

Administering the albuterol first opens the airways (bronchodilation), allowing the fluticasone (corticosteroid) to penetrate deeper into the lungs. Waiting 1 to 5 minutes between different inhalers is the standard practice to allow the first drug to act.

Question 2

The MAR instructs the Medication Aide to administer digoxin 0.125 mg orally and to "hold for heart rate less than 60." The MA-C takes Mr. Harrison's radial pulse and counts 56 beats per minute. What is the MA-C's best action?

  • A) Give the medication and document the heart rate of 56 in the MAR.
  • B) Hold the medication, document a refusal, and notify the physician.
  • C) Wait 15 minutes, recheck the pulse, and administer the dose if it rises above 60.
  • D) Withhold the medication and immediately notify the delegating nurse.✓
Show rationale

When a vital sign falls outside the ordered parameters, the MA-C must withhold the dose and immediately report the finding to the delegating nurse for further assessment and instruction.

Question 3

When a resident is prescribed both an ophthalmic solution (eye drops) and an ophthalmic ointment for the same eye at the same time, which administration technique is correct?

  • A) Instill the drops first, wait 3 to 5 minutes, then apply the ointment.✓
  • B) Apply the ointment first, wait 1 minute, then instill the drops.
  • C) Instill the drops and apply the ointment immediately after to prevent eye irritation.
  • D) Mix the drops and ointment in the lower conjunctival sac simultaneously.
Show rationale

Drops must be instilled first because they absorb quickly. Waiting 3 to 5 minutes allows the drops to absorb fully before the ointment is applied, which creates a barrier.

Question 4

Mrs. Gable has an order for a nitroglycerin transdermal patch to be applied daily at 0900. When preparing to apply the new patch, the Medication Aide notices yesterday's patch is still on her right upper chest. What is the correct sequence of actions?

  • A) Apply the new patch to the left upper chest, then remove the old patch from the right side.
  • B) Remove the old patch, fold it in half with the sticky sides together, and apply the new patch to a different hairless area.✓
  • C) Remove the old patch, wipe the site clean, and apply the new patch to the exact same location.
  • D) Leave the old patch in place and apply the new patch next to it to maintain steady medication levels.
Show rationale

The correct procedure is to remove the old patch first, fold it sticky-side in for safe disposal, and rotate the application site by placing the new patch on a different clean, hairless area.

Question 5

A resident has difficulty swallowing and requests that all morning pills be crushed and mixed with applesauce. The MAR lists an acetaminophen tablet, a lisinopril tablet, and a pantoprazole delayed-release (DR) tablet. What is the Medication Aide's most appropriate action?

  • A) Crush all three tablets and mix them thoroughly into the applesauce.
  • B) Crush the pantoprazole DR and lisinopril, but administer the acetaminophen whole.
  • C) Crush the acetaminophen and lisinopril, but consult the nurse regarding the pantoprazole DR.✓
  • D) Refuse the resident's request and encourage them to swallow the pills whole with water.
Show rationale

Standard tablets like acetaminophen and lisinopril can generally be crushed. However, delayed-release (DR), enteric-coated (EC), or extended-release (ER) medications must never be crushed. The MA-C must hold the DR med and ask the nurse for an alternative order.

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