Pharm NCLEX A #22-#44

A nurse needs to administer a prescribed heparin injection to a client subcutaneously. Which of the following syringes ensures accuracy when administering heparin subcutaneously? A) Tuberculin syringe B) Conventional syringe C) Insulin syringe D) Syringe calibrated in 0.2 ml increments

Ans: A Feedback: Heparin dosages are very small volumes; hence, they may require a tuberculin syringe to ensure accuracy. Conventional syringes and needles are being redesigned to avoid needle-stick injuries and ensure accuracy. Insulin syringes are specially designed to prepare insulin dosages. A syringe calibrated in 0.2 ml is used in 3 or 5 ml dosages for an intramuscular injection.

A nurse needs to administer a subcutaneous injection to a client and will avoid any site that was recently used. Which of the following distances from an older site should the nurse maintain when choosing a new injection site? A) About a finger's width apart B) About two fingers' width apart C) About three fingers' width apart D) About four fingers' width apart

Ans: A Feedback: Injection sites are rotated a finger's width apart or about 1 in. from a previous site to avoid repeatedly injecting into the same area in a short amount of time. Rotating sites avoids tissue injury.

A nurse needs to administer an intradermal injection to a client. Which of the following is the most common site for administering an intradermal injection? A) Forearm B) Chest C) Back D) Stomach

Ans: A Feedback: The most common site for an intradermal injection is the inner aspect of the forearm. Intradermal injections are commonly used for diagnostic purposes. Examples include tuberculin tests and allergy testing. Small volumes, usually 0.01 to 0.05 ml, are injected because of the small tissue space. Other areas that may be used are the back and the upper chest, not the stomach.

A nurse needs to combine two different prescribed drugs in a syringe and then administer them to a client. Which of the following precautions should the nurse take when preparing and administering these drugs? A) Withdraw exact amounts of each drug from each container. B) Inject half of the final contents of the syringe into one site and the second half into a different site. C) Shake the syringe for at least 30 seconds after drawing up each drug. D) Expel both the drugs separately into a third container before drawing them up for administration.

Ans: A Feedback: When combining more than one drug in a single syringe, the nurse should take exact amounts from each drug container because once the drugs are in the barrel of the syringe, there is no way to expel one without expelling the other. It is unnecessary to shake the syringe for 30 seconds or to use two injection sites. The two drugs would not be combining in a third, separate container before being drawn up.

A nurse is administering an injection to a client with the needle at a 15-degree angle. Which of the following injections can be administered at this angle? A) Intradermal B) Subcutaneous C) Intramuscular D) Intravenous

Ans: A Feedback: When giving an intradermal injection, the nurse instills the medication shallowly at a 10- to 15-degree angle of entry. When the nurse administers a subcutaneous injection, the angle of entry is either 45 degrees or 90 degrees, whereas for intramuscular injections the angle is 90 degrees.

A hospital client with type 1 diabetes requires the administration of 4 units of regular (short-acting) insulin and 12 units of NPH (long-acting) insulin. The nurse knows to combine these two types of insulin immediately before administration. What is the rationale for the nurse's action? A) Leaving the insulins combined for too long reduces the individual characteristics of each B) Having the insulins remain combined in the syringe increases the likelihood that precipitates will form C) Combining the insulins for an extended period is associated with the growth of microorganisms in the syringe D) Having the insulins combined for more than 15 minutes can cause cytotoxic effects (cell death) after administration

Ans: A Feedback: When mixed together, insulins tend to bind and become equilibrated. This means that the unique characteristics of each are offset by those of the other. For this reason, most types of insulin are combined just before administration. Combining insulins too early does not create a risk of precipitate formation, infection, or cytotoxicity.

A hospital is in the process or replacing the current stock of conventional syringes and needles with new, redesigned models. What is the priority outcome that is sought by this change? A) Increased accuracy of parenteral drug doses B) Reduction in nurses' risks of needlestick injuries C) Interchangeability of needles for subcutaneous and intramuscular injections D) Reduction in clients' risks of nosocomial infections

Ans: B Feedback: Conventional syringes and needles are being redesigned to avoid needlestick injuries and thus to reduce the risk for acquiring a blood-borne viral disease such as hepatitis or AIDS. Redesigned syringes in needles do not increase the accuracy of drug administration or reduce the risk of nosocomial infections. Subcutaneous and intramuscular injections require different sized needles.

After administering medication to a client subcutaneously, the nurse removes the needle at the same angle at which it was inserted. Which of the following explains the nurse's action? A) Verifies correct injection of the drug B) Minimizes tissue trauma to the client C) Prevents needle-stick injuries D) Helps to control placement of the needle

Ans: B Feedback: Removing the needle at the same angle at which it was inserted to administer medication minimizes tissue trauma and discomfort to the client. To verify correct injection of the drug, the nurse pushes the plunger and watches for a small wheal. To prevent needle-stick injuries, the nurse covers the needle with a protective cap. Holding the client's arm and stretching the skin taut helps to control placement of the needle.

A nurse needs to administer an intramuscular injection to a client in the client's dorsogluteal site. Which of the following actions should the nurse perform first to locate the appropriate landmarks and avoid damaging the sciatic nerve? A) Palpate the sciatic nerve before proceeding with the injection. B) Divide the buttock into four imaginary quadrants. C) Place one hand above the knee and the other at the top of the thigh. D) Palpate the lower edge of the acromion process.

Ans: B Feedback: The dorsogluteal site contains the sciatic nerve. To locate the appropriate landmarks of the dorsogluteal site, the nurse should divide the buttock into four imaginary quadrants. Palpation of the sciatic nerve before proceeding with the injection is not done. The nurse locates the vastus lateralis site by placing one hand above the knee and the other below the greater trochanter at the top of the thigh. Palpating the lower edge of the acromion process is done for safety reasons when administering an injection at the deltoid site.

A nurse needs to administer an intramuscular injection to a thin and frail elderly client. Which of the following actions should the nurse perform to avoid striking the bone when injecting? A) Massage the injection site. B) Pinch the muscular tissue. C) Obtain an x-ray of the injection site. D) Inject using subcutaneous rather than intramuscular technique.

Ans: B Feedback: The muscular tissue should be pinched together to avoid striking the bone when administering an intramuscular injection, if the older person has decreased subcutaneous fat. Massaging the injection site will not help avoid the possibility of striking the bone. Performing the injection using a subcutaneous rather than intramuscular technique is not done because injection techniques are not interchangeable. It is not common practice to obtain an x-ray for administering an injection.

A nurse is showing an elderly client the correct method of self-administering an insulin injection at home using an insulin pen. Which of the following points should the nurse tell the client in order to avoid lipoatrophy and lipohypertrophy? A) Change the needle daily. B) Rotate the site with each injection. C) Apply local anesthetic to the injection site a few minutes prior to injection. D) Massage the injection site for 30 seconds after administration.

Ans: B Feedback: The nurse should tell the client to rotate the injection site each time an insulin injection is administered to prevent lipoatrophy and lipohypertrophy. The needle should be changed after each injection, not only once per day. Local anesthetic need not be applied to the injection site when administering insulin as the needle used causes very little discomfort. There is also no need to massage the injection site when insulin is administered.

A nurse is using the Z-track technique to administer an injection to a client. Which of the following injection routes utilizes the Z-track technique? A) Intravenous B) Intramuscular C) Intradermal D) Subcutaneous

Ans: B Feedback: When administering intramuscular injections, nurses may administer drugs that may be irritating to the upper levels of tissue by the Z-track technique. Clients report slightly less pain during and the next day after a Z-track injection compared with the usual intramuscular injection technique. The Z-track technique is not suitable for intravenous injections as they are administered into the veins, nor is it used for intradermal or subcutaneous injections.

As part of a postsurgical client's regimen for deep vein thrombosis prevention, she is to receive 5000 units of heparin subcutaneously b.i.d. How can the nurse reduce this client's risk of bruising at the injection sites? A) By aspirating slightly once, the needle is inserted B) By gently massaging the injection site for a few seconds after injection C) By changing the needle after withdrawing the drug from the vial D) By using the Z-track injection technique consistently

Ans: C Feedback: Certain modifications are necessary to prevent bruising in the area of heparin injection. The nurse changes the needle after filling the syringe with the dose of heparin; that is, before injecting the client. The nurse does not aspirate the plunger once the needle is in place. Massaging the site is contraindicated because this can increase the tendency for local bleeding. The Z-track technique is used exclusively for IM injections.

A nurse is using an 18-gauge needle to administer a medication to a client. The nurse knows that when compared to a 27-gauge needle, an 18-gauge needle has which of the following features? A) Shorter length B) Greater length C) Larger diameter D) Smaller diameter

Ans: C Feedback: For most injections, 18- to 27-gauge needles are used; the smaller the number, the larger the diameter. For example, an 18-gauge needle is wider than a 27-gauge needle. The needle gauge or the diameter refers to its width.

A nurse is administering a subcutaneous injection to a client. What is the maximum volume that the nurse may administer by this route? A) 3 ml B) 2.5 ml C) 1 ml D) 0.05 ml

Ans: C Feedback: The volume of a subcutaneous injection is usually up to 1 ml. An intramuscular injection is the administration of up to 3 ml of medication into one muscle or muscle group. Intradermal injections are commonly used for diagnostic purposes in small volumes, usually 0.01 to 0.05 ml.

A nurse needs to administer an intramuscular injection to a client in the deltoid site. Which of the following actions will reduce the risk of damaging the client's radial nerve or artery? A) Avoid asking the client to lie down or sit. B) Aspirate for blood return from the tissue. C) Draw an imaginary line at the axilla between the acromion and brachial vessels. D) Pull the tissue laterally until it is taut.

Ans: C Feedback: To avoid the risk of damaging the radial nerve and artery in the deltoid site, the nurse should draw an imaginary line at the axilla first and then inject between the acromion and brachial vessels. The nurse should ask the client to lie down, sit, or stand with the shoulder well exposed. Pulling the tissue until it is taut and aspirating blood return from the tissue is part of the Z-track method, not part of the technique used to avoid the risk of damaging the radial nerve and artery.

A nurse has administered an injection to a client. Which of the following interventions should the nurse perform to reduce discomfort and provide quick relief? A) Instill the medication as rapidly as possible. B) Numb the skin with an ice pack after the injection. C) Apply pressure to the site during needle withdrawal. D) Apply a eutectic mixture of local anesthetic to the site after administration.

Ans: C Feedback: To reduce the discomfort associated with an injection, the nurse should apply pressure to the site during needle withdrawal. Applying a eutectic mixture of local anesthetic to the site is done before injection, not after injection. The nurse should numb the skin with an ice pack not after the injection, but before it. The injection should take place steadily and slowly, not as quickly as possible.

A nurse has just administered a subcutaneous dose of morphine to a client who is experiencing significant pain. What is the first action that the nurse should do after withdrawing the needle from the client's arm? A) Apply a 2 ◊ 2 gauze to the injection site B) Provide firm pressure on the injection site for 10 to 15 seconds C) Deposit the syringe and needle in a designated sharps container D) Initial the client's medication administration record

Ans: C Feedback: To reduce the risk of needlestick injuries, the nurse should immediately dispose of the needle and syringe after administration. This should be done before the nurse completes the necessary documentation. Sustained pressure or the application of gauze is not necessary.

A group of nursing students have begun learning about the rationale and technique for administering injections. The students should identify which of the following parts of a syringe? Select all that apply. A) Orifice B) Piston C) Barrel D) Tip E) Plunger

Ans: C, D, E Feedback: All syringes contain a barrel (part of the syringe that holds the medication), a plunger (part of the syringe within the barrel that moves back and forth to withdraw and instill the medication), and a tip or hub (part of the syringe to which the needle is attached).

A nurse is bunching (pinching) the tissue of a client when administering a subcutaneous injection. What is the reason for bunching when injecting subcutaneously? A) To prevent needle-stick injuries B) To ensure the accuracy of landmarking C) To facilitate blood circulation at injection site D) To avoid instilling medication within the muscle

Ans: D Feedback: Nurses bunch tissue between the thumb and fingers before administering the injection to avoid instilling medication within the muscle. Bunching does not prevent needle-stick injuries, it does not facilitate blood circulation at the injection site, nor does it ensure the accuracy of landmarking.

A nurse has to administer a subcutaneous injection to a client. For which of the following clients can the nurse most safely administer a subcutaneous injection at a 90-degree angle? A) An infant B) A thin client C) A school-aged child D) An obese client

Ans: D Feedback: The nurse inserts the needle at a 90-degree angle to reach the subcutaneous tissue in a normal-size or obese client who has a 2-in. tissue fold when it is bunched. For thin clients who have a 1-in. fold of tissue, the nurse inserts the needle at a 45-degree angle. Bunching is preferred for infants, most children, and thin adults.

A nurse should read the instructions stated on a vial before reconstituting it and administering it to a client. Which of the following instructions are stated on the label of a vial? A) Type of needle to be used for withdrawal B) Directions for administering the drug C) Best site for administering the drug D) Amount of diluent to be added

Ans: D Feedback: When reconstitution is necessary, the drug label lists instructions such as the amount of diluent to be added and the type of diluent to be used, but not the type of needle. The label states the dosage per volume after reconstitution, not the best site for administering the drug after the reconstitution. It also states the directions for storing the drug, not the directions for administering the drug to a client.

A nurse is administering an intramuscular injection to a client using the Z-track technique. Which of the following actions should the nurse perform during this administration? A) Withdraw the needle and release taut skin immediately after injection. B) Depress the plunger with the index finger of the nondominant hand. C) Apply pressure and massage the site immediately after withdrawing the needle. D) Use the side of the hand to pull the tissue laterally about 1 in. before injection.

Ans: D Feedback: When using the Z-track technique, the nurse should use the side of the hand to pull the tissue laterally about 1 in. (2.5 cm) until the tissue is taut. The needle is depressed with the thumb, not the finger, and the needle should be left in place for several seconds following injection. Massage is contraindicated.