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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

While administering morning medications, the Medication Aide (MA-C) realizes they just gave Mr. Smith a blood pressure pill intended for Mr. Stevens. What is the MA-C's immediate priority?

▸ Why D is the answer

Notifying the delegating nurse immediately is correct because the resident's safety is the top priority, and a licensed nurse must perform a clinical assessment to manage any potential adverse effects. Inducing vomiting is tempting as a way to reverse the error, but it is highly dangerous, outside the MA-C scope of practice, and contraindicated for many medications. Completing an incident report is a mandatory step, but it is an administrative task that must happen after the immediate safety of the resident has been secured by the nurse. Checking the resident's blood pressure is tempting because it relates to the specific medication given, but the MA-C must not delay reporting the error to perform an assessment they are not qualified to interpret.

Question 2

A resident with dementia spits out their morning dose of donepezil and refuses to take it. The resident's daughter, who is visiting, suggests crushing the pill and hiding it in the resident's applesauce. How should the Medication Aide (MA-C) respond?

▸ Why A is the answer

Documenting the refusal and notifying the nurse is correct; residents have the right to refuse medication, and the MA-C must report this change so the nurse can evaluate the situation and follow up. Crushing the pill and hiding it is tempting because the family consented, but covert administration (hiding meds) violates the resident's rights and requires specific physician orders and care plan protocols. Re-administering a new pill is tempting to ensure the resident gets their dose, but forcing or tricking a resident who has actively refused is a violation of their rights. Asking the daughter to feed the hidden medication is tempting to shift responsibility, but the MA-C is still facilitating unauthorized covert administration, which is strictly prohibited.

Question 3

To adhere to the "Right Documentation" principle of medication administration, at which exact point must the Medication Aide (MA-C) sign the Medication Administration Record (MAR)?

▸ Why B is the answer

Documenting immediately after witnessing the resident receive the medication is correct; this ensures accurate, real-time tracking and prevents other staff from accidentally administering a duplicate dose. Documenting immediately after preparation (pre-charting) is tempting to save time, but it is a dangerous error; if the resident subsequently refuses or drops the pill, the MAR will falsely show it was given. Documenting at the end of the shift (batch-charting) is tempting for efficiency, but it relies on memory, increasing the risk of omissions or double-dosing by other staff. Documenting upon verbal agreement is tempting, but the resident may still drop, pocket, or spit out the medication; documentation must only occur after actual administration.

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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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