Unit 4 Case Study

A nurse is teaching a client about selecting injection sites for insulin. Which of the following sites should the nurse recommend as best for injection? A. The abdomen below the costal margins to the iliac crests B. The outer aspects of the upper arms C. The anterior surface of the thighs D. The upper back in the scapular area

A Compared to other injection sites, the abdomen provides for the fastest and most consistent absorption of insulin. The client should use sites at least 5.8 cm (2 in) from the umbilicus.

A nurse is preparing to administer an insulin injection to a client. Which of the following actions should the nurse take? A. Insert the needle at a 45° angle into pinched skin. B. Pull the skin 2.5 cm (1 in) to the side with the ulnar surface of the nondominant hand. C. Insert the needle at a 15° angle to form a wheal when injecting the medication. D. Aspirate for blood for 5 to 10 seconds after inserting the needle.

A When administering a subcutaneous injection, the nurse must be sure to access the subcutaneous tissue. Unless the client has adipose tissue of greater than 1.3 cm (0.5 in), the nurse should pinch the skin and insert the needle at a 45° to 60° angle.

A nurse is preparing to administer an insulin injection. Which of the following needles should the nurse select? A. 21 gauge, 1 1/2 inch needle B. 30 gauge, 5/8 inch needle C. 23 gauge, 1 inch needle D. 25 gauge, 1/4 inch needle

B The nurse should use a 25 or 30 gauge, 5/8-inch needle when administering a subcutaneous injection at a 45° angle, and a 25 or 30 gauge, 3/8-inch needle when administering a subcutaneous injection at a 90° angle. The nurse should base this decision on the size of the client and the amount of adipose tissue at the site.

A nurse is teaching a client who is start self-administering a regimen of regular and NPH insulin twice each day. Which of the following instructions should the nurse include? A. Store unopened vials of insulin in the freezer. B. Allow 1.3 cm (0.5 in) between injection sites within the same area. C. Keep prefilled syringes in the refrigerator for up to 1 week. D. Draw up the NPH insulin before the regular insulin.

C The client can prefill syringes with the appropriate dose and keep them in the refrigerator for up to 1 week. He should keep the syringes in the upright position, which will prevent clogging of the needle, and resuspend the insulin prior to administering by gentle agitation.

A nurse is preparing to administer 6 units of regular insulin and 20 units of NPH insulin to a client. Which of the following actions should the nurse take first? A. Withdraw 6 units of insulin from the regular insulin vial. B. Inject 6 units of air into the regular insulin vial. C. Withdraw 20 units of insulin from the NPH insulin vial. D. Inject 20 units of air into the NPH insulin vial.

D When drawing up regular insulin and NPH insulin into the same syringe, the nurse needs to prevent contaminating the regular insulin with the protein in the NPH insulin. The nurse can do this by first injecting the amount of air equal to the amount of insulin she will withdraw from the NPH vial.