The MACE certifies nurse aides who have completed medication aide training to legally administer medications in settings like skilled nursing facilities and assisted living. States call the credential by slightly different names — Colorado and Utah call it Medication Aide Certification, South Carolina calls it Medication Assistant Certification — but the exam content and structure are the same national test everywhere it's used.
The exam is sixty multiple-choice questions, and you get two hours to finish. Fifty of those questions are scored; ten are unscored pretest items being evaluated for future exams. You cannot tell which ten are pretest items, so there's no shortcut — answer every question as if it counts, because from your seat, it does.
It's delivered as an online proctored exam, and most states score it immediately when you submit. Whether you're eligible to sit for it, and what training has to precede it, is set by your state's licensing board rather than by the exam itself — check your own state's candidate handbook through Credentia before you register, since eligibility rules, fees, and renewal periods vary from state to state.
Item | Detail |
|---|---|
Questions | 60 total (50 scored, 10 unscored pretest) |
Time limit | 2 hours |
Format | Online, proctored, computer-based |
Scoring | Immediate, in most states |
Passing score | Not published by Credentia |
Fee | Varies by state |
Eligibility | Set by state licensing board; typically requires completed medication aide training |
Renewal | Varies by state (commonly every one to two years) |
The content outline has three domains, and they are nowhere near equal in weight. One domain alone is worth 60% of the scored questions.
Domain | Weight | Scored questions |
|---|---|---|
II. Medication Administration, Observation and Reporting | 60% | 30 |
III. Medication Concepts and Measurements | 24% | 12 |
I. Authorized Duties | 16% | 8 |
Domain II covers administering and charting medications (orders, documentation, storage, disposal), safety and rights of medication administration, routes of administration, how the body processes medication, drug classifications by body system, individual rights, medication errors, and reporting symptoms, side effects, and any change from a client's normal condition. If you only have time to master one domain, this is it — nearly two out of every three scored questions live here.
Domain III covers terminology and abbreviations, dosage range, drug actions and side effects (including idiosyncratic, paradoxical, and antagonist reactions), precautions, interactions, and forms and measurements of medication.
Domain I covers building relationships, delegation, the role of the certified medication aide (MA-C), specific legal and ethical issues, and where to find resources — nurse, pharmacist, physician, package inserts, drug reference manuals.
Most training programs teach the rights of medication administration as a checklist to recite. The exam tests whether you can spot which right was violated in a described scenario — wrong time, wrong route, wrong documentation — which is a different skill than reciting the list from memory.
Domain II folds "causes and reporting of medication errors," "reporting of symptoms and side effects," and "reporting any change from client's normal condition" into the same 60% block as the mechanics of giving a medication. Candidates who study the administration steps hard and treat reporting as an afterthought are underpreparing for a third of that domain.
The outline specifically calls out classifications like antimicrobials, cardiovascular, dermatological, and endocrine medications. This is about understanding what a category of drug does and what to watch for, not memorizing specific brand names — practice questions that only quiz brand-name recall miss the actual skill being tested.
Domain III's "measurements" subtopic is easy to skim past in a content outline, but it's where dosage calculation errors happen. Get comfortable converting between the units your training program used and the units a question might phrase differently.
Domain I isn't only "what can an MA-C do." It also covers delegation and specific legal and ethical issues — questions about when you must refuse a task, or when something needs to go back to a nurse, fall here and are easy to miss if you only studied the permitted-duties list.
Given the 60/24/16 split, your practice time should roughly mirror the exam's weighting — spend more of it in Domain II than in the other two combined, not because it's harder, but because it's worth more.
Because ten questions are unscored and indistinguishable from the fifty that count, don't practice a habit of skipping ones that feel like a rehearsed trick question. Treat every question the same way on test day.
Use scenario-based practice questions, not just recall questions. A question that says "the medication order says X, but you observe Y — what do you do" tests the same judgment the exam does, and it's a different mental muscle than matching a drug name to a category.
Under-preparing Domain III's calculation and measurement content because it feels like "just math" is a frequent one — a missed unit conversion is graded the same as any other wrong answer.
Confusing the reporting requirements in Domain II with the administration steps, so that candidates know how to give a medication correctly but not what to do or document afterward.
Treating the two-hour time limit as generous. Sixty questions in two hours is two minutes per question on average, which is workable, but candidates who get stuck rethinking one difficult scenario question can run themselves short toward the end.
Starting point | Rough timeline | Where to focus |
|---|---|---|
Just finished medication aide training | 2 to 3 weeks | Domain II in depth, then measurements and conversions in Domain III |
Working CNA with prior medication exposure | 1 to 2 weeks | Reporting requirements and rights of medication administration, since routine administration is already familiar |
Retaking after a fail | 1 to 2 weeks | Rebuild from your score report if your state provides a domain breakdown; if not, revisit Domain II first given its weight |
The three-domain content outline in current use has been stable for years and is still the version referenced in 2026 state candidate handbooks. The more relevant recent change isn't to the test content — it's to who owns it: NCSBN has stated it no longer develops or owns the MACE content, and directs exam and scheduling questions to Credentia. The domains and weightings haven't shifted, but confirm your state's current candidate handbook for anything state-specific, since eligibility, fees, and renewal timelines are set at the state level and do change.
Last updated on Oct, 5 2026
