Pharmacological Principles

A client with diabetes is being taught to self-administer a subcutaneous injection of insulin. Identify the preferred site for the self-administration of this medication.

The abdomen Rationale: The abdomen is the preferred site for an insulin injection because it is easily accessible and absorption is more even and rapid than when it is injected in the extremities. The other available options are not the preferred site for the self-administration of insulin.

Which is the maximum recommended dose of an intramuscular injection in a toddler?

1 mL

The health care provider prescribes enoxaparin to be administered subcutaneously. To ensure client safety, which measure would the nurse take when administering this medication?

Administer in the abdomen area only. Rationale: The preferred site for enoxaparin administration is the abdomen. According to package directions, the air pocket in the prepackaged syringe should not be removed. Rubbing the injection site also is contraindicated. Subcutaneous injections should not be given over 2 minutes.

To prevent excessive bruising when administering subcutaneous heparin, which technique will the nurse employ?

Avoid massaging the injection site after the injection. Rationale: The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The medication should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally, heparin is provided by the pharmacy department in single-dose syringes.

The nurse is discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes. Which information is important for the nurse to include concerning insulin administration?

Insulin will be required throughout life. Rationale: All those involved must understand that the child does not have an endogenous source of insulin and will require insulin administration throughout life. At this time there is no oral insulin with which to treat type 1 diabetes. Insulin needs decrease, not increase, during exercise. Insulin needs increase, not decrease, in the presence of an infection.

A client who sustained a leg fracture is prescribed intramuscular analgesic medication. Which health care professional can be safely delegated this task?

Licensed practical nurse (LPN) Rationale: An LPN is authorized to administer oral and intramuscular medications. An RN is a delegator who can administer intravenous medications. PCAs and UNPs are unlicensed personnel who can perform tasks such as positioning the client and maintaining the hygiene of the client.

After teaching a family member how to administer subcutaneous enoxaparin sodium, how will the nurse evaluate the effectiveness of the training?

Observing the family member administering enoxaparin sodium to the client. Rationale: The best way to evaluate the effectiveness of the teaching is to observe the family member administering the medication to the client. The family member may be able to perform a subcutaneous injection on a manikin but fear hurting the family member. Knowing the side effects of enoxaparin sodium is important, but it does not provide any information as to the family member's ability to administer the medication. The family member may be able to verbalize all the steps but fear puncturing the skin with the needle.

A client has a prescription for a sublingual nitroglycerin tablet. Which technique will the nurse teach the client to use?

Place the pill under the tongue and let it dissolve. Rationale: Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood. The buccal route requires placing medication between the cheek and gums. Chewing the pill and then swallowing it may be done for oral administration of some large pills, but not with the sublingual route of administration. Taking the pill with water is required with the oral route of administration of medication, but not with sublingual. In addition, a full glass of water may be an excessive amount of fluid to swallow one pill.

Enoxaparin 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given for which purpose?

To provide prophylaxis against postoperative thrombus formation Rationale: Enoxaparin, a low-molecular-weight heparin, prevents the conversion of fibrinogen to fibrin and of prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III. Enoxaparin is not an antipyretic. Enoxaparin is not an analgesic. Enoxaparin is not an anti-inflammatory medication.

The medication prescribed for an infant is to be given intramuscularly. Which site will the nurse select for administration of the medication?

Vastus lateralis Rationale: Intramuscular injections are given in the vastus lateralis muscle of the thigh in infants. The ventrogluteal site is not used until children have been walking. The dorsogluteal site is considered high risk for damage to the sciatic nerve or a major blood vessel. The deltoid site in the arm has a small muscle mass that limits the amount of medication that can be injected.