Module 7:5 IM Injections for Final

The nursing instructor is reviewing with the students the Z-track method for administering an IM injection. Which statement(s), if made by a student, indicates further instruction is needed? "IM injections require aspiration to ensure that the medication is not administered directly into a blood vessel." "Use the nondominant hand to pull the skin to the side and to stabilize the syringe barrel when aspirating." "The Z-track technique should be used for all IM injections." "The Z-track technique creates a zigzag path through the tissues that seals the needle track and avoids the tracking of medication." "A fast injection rate of the medication reduces pain and tissue trauma." "The needle should be removed after the skin is released."

-"A fast injection rate of the medication reduces pain and tissue trauma" -"The needle should be removed after the skin is released." A fast needle insertion but a slow injection rate of the medication will aid in reducing pain and tissue trauma. The needle should be removed before the skin is released. Releasing the tissue seals the needle track. The remaining statements are accurate.

The nurse has the medication administration record, the vial of medication, alcohol swabs, and medication label. Choose the remaining equipment that the nurse will need to administer 1 mL of medication, which first has to be reconstituted, as an IM injection to an average-size adult: 21- to 25-gauge needle. 50- or 100-unit syringe. 3/8-inch needle. 25- to 27-gauge needle. Diluent. Needle for withdrawing. Disposable gloves. 1- to 3-mL syringe. 1- to 1.5-inch needle.

-Needle for withdrawing -Dilute -1- to 3-mL syringe -Disposable gloves -21- to 25-gauge needle -1 to 1.5 inch needle A needle for withdrawing and an unopened alcohol swab are used for withdrawing diluent, for injecting diluent into the medication vial, and for withdrawing the reconstituted medication from the medication vial. Disposable gloves are indicated when administering the injection to the patient for personal protection from possible contact with body fluids. The needle used for withdrawing medication will be changed before administration because the needle may become dull from entering the rubber stopper of the vial of diluent or the vial of medication. This will help prevent tracking of the medication left on the shaft of the needle and prevent pain from using a dull needle. Because the injection is to be given intramuscularly, the preferred size for administration is a 21- to 25-gauge, 1- to 1.5-inch needle. A 1- to 3-mL syringe is the preferred choice for an IM injection of this amount given to an adult.

An 81-year-old cachetic woman (weighing 40 kg) requires iron dextran 1 mL intramuscularly. How will the nurse administer this injection? Avoid aspirating because this will increase tissue irritation. Choose a 21-gauge, 0.5- to 1-inch needle and administer the injection with the Z-track technique at a 90-degree angle. Choose a 21-gauge, 1-inch needle and administer the injection with the Z-track technique at a 45-degree angle. Choose a 21-gauge, 1.5-inch needle and administer the injection at a 90-degree angle.

Choose a 21-gauge, 0.5- to 1-inch needle and administer the injection with the Z-track technique at a 90-degree angle. A thin patient may require only a 0.5- to 1-inch needle. A larger gauge is chosen because iron dextran is viscous. The angle of insertion for an IM injection is 90 degrees. All IM injections should be given with the Z-track technique. Most IM injections should be aspirated to avoid administering medication directly into a blood vessel.

While preparing an IM injection, the nurse withdraws the syringe needle from a multi-dose vial and touches the hub of the needle. What should the nurse do? Discard the needle. Administer the injection. Discard the vial. Discard the needle and syringe.

Discard the needle

A patient is in severe pain. The nurse has an order for morphine sulfate 5 mg intramuscularly or subcutaneously. What is the nurse's best nursing action? Assess the patient's respiratory rate. Have naloxone (Narcan) available and notify the health care provider. Give the morphine subcutaneously because this route will allow it to be absorbed more rapidly. Give the morphine intramuscularly because this route will allow it to be absorbed more rapidly. Give the morphine intravenously because this route will allow it to be absorbed more rapidly.

Give the morphine intramuscularly because this route will allow it to be absorbed more rapidly. Given the order, the IM route would be preferred for more rapid absorption. The patient's respiratory rate should be assessed before morphine is administered. Naloxone is an antidote for opioid overdose and would be inappropriate in this case.

Of the three types of injections, intradermal, subcutaneous, and IM, which requires aspiration of the syringe before injecting the prepared medication? IM. Intradermal. Both IM and subcutaneous. Subcutaneous.

IM IM injections require aspiration to ensure that the medication is never administered directly into a blood vessel. It is unnecessary to aspirate during an intradermal injection because the dermis is relatively vascular. Piercing a blood vessel during a subcutaneous injection is very rare, so aspiration is unnecessary.

Which of the following accurately describes how to locate the ventrogluteal site? Three finger widths below the acromion process. Place heel of hand over patient's greater trochanter thumb toward the patient's buttock; index finger points to the iliac crest, and middle finger extends along anterior superior iliac spine. Place heel of hand over the patient's greater trochanter, thumb toward the patient's groin; index finger points to the anterior superior iliac spine, and middle finger extends back along the iliac crest. A handbreadth above the knee to a handbreadth below the greater trochanter.

Place heel of hand over the patient's greater trochanter, thumb toward the patient's groin, index finger points to the anterior superior iliac spine, and middle finger extends back along the iliac crest. Use the right hand for the patient's left hip and the left hand for the patient's right hip. The nurse's thumb should be pointing toward the patient's groin. The index finger points to the anterior superior iliac spine and the middle finger extends back along the iliac crest toward the buttock. The index finger, the middle finger, and the iliac crest form a V-shaped triangle. The injection site is the center of the triangle. Three finger widths below the acromion process the nurse will find the deltoid muscle. The vastus lateralis muscle is a handbreadth above the knee to a handbreadth below the greater trochanter.

The nurse has to give a 1-month-old the hepatitis B vaccine. Which is the best site for administration? Deltoid. Ventrogluteal. Vastus lateralis. Dorsal gluteal.

Vastus lateralis The vastus lateralis is the preferred IM injection site for infants. The deltoid site is the preferred site for hepatitis B vaccine administration in adults. The dorsal gluteal site is inappropriate for infants or adults because of its close proximity to the sciatic nerve.

A patient just underwent hip replacement surgery and has an abduction pillow. The health care provider has ordered an injection of 15 mg morphine sulfate intramuscularly for acute pain. What would be the preferred site for administering an IM injection to this patient? Ventrogluteal muscle. Abdominal muscle. Vastus lateralis muscle. Deltoid muscle.

Vastus lateralis muscle The vastus lateralis is accessible and of a size appropriate for this injection. The deltoid muscle is small and less ideal than the vastus lateralis. The abdomen is a subcutaneous injection site. The patient cannot be turned properly to administer the medication by way of the ventrogluteal muscle.

The nurse is administering a preoperative medication intramuscularly. As the nurse aspirates, the nurse sees blood return into the syringe. What should the nurse do next? Administer it anyway because the patient cannot be late for the scheduled surgery. Notify the health care provider that this occurred. Withdraw and insert the same needle, moving it over approximately 1 inch. Withdraw the needle and start over.

Withdraw the needle and start over Patient safety is the priority. If blood appears in the syringe, remove the needle and dispose of the medication and syringe properly. Prepare another dose of medication for injection. A new dose must be prepared to be able to visualize whether a blood vessel is entered in the second attempt.