Module 7: Injections

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?

-"A fast injection rate of the medication reduces pain and tissue trauma" -"The needle should be removed after the skin is released."

The nurse is administering a subcutaneous injection of enoxaprin (Lovenox). Which of the following actions would minimize pain and discomfort for the patient?

-Asking the patient to relax the site chosen for injection. -Inserting the needle quickly

The nurse has the medication administration record, the vial of dry medication, alcohol swabs, and a medication label. Identify the remaining equipment needed to administer intramuscularly to an average-size adult 1 mL of medication from a vial that requires reconstitution:

-Needle for withdrawing -1- to 3-mL syringe -Disposable gloves -21- to 25-gauge needle -1 to 1.5" length needle

The nurse has the medication administration record, the vial of medication, and alcohol swabs. Identify the remaining equipment needed to deliver 0.3 mL of medication subcutaneously from a liquid vial to an average-size adult:

-Needle for withdrawing -25- to 27-gauge needle -Disposable gloves -1 to 1.5 inch needle -1-mL syringe

Immediately after an allergy injection, the nurse's 20-year-old patient tells the nurse "I feel funny." The nurse's immediate actions are to:

-Take the patient's vital signs. -Observe the patient for difficulty breathing. -Prepare to give epinephrine subcutaneously or an antihistamine such as diphenhydramine (Benadryl) according to health care provider's orders and/or agency protocol.

Given the medication order digoxin (Lanoxin) 100 mcg IM daily and medication label, the correct dose is _______ mL. Do not include the unit of measure in answer; only calculated dose.

0.4

Given the medication order morphine sulfate 5 mg subcutaneous q4h and medication label, the correct dose is ______ mL. Do not include the unit of measure in answer; only calculated dose.

0.5

Given the medication order states morphine sulfate 7 mg and atropine 0.3 mg IM preoperatively and medication labels, ______ mL is the total volume to be administered.

1.5

Given the medication order streptomycin sulfate 0.64 g IM daily and medication label, the correct dose is ______ mL. Do not include the unit of measure in answer; only calculated dose.

1.6

The nurse is preparing to give an injection for allergy testing; what would be the best needle gauge to use?

25 or 27 A narrow, fine needle is needed to enter the intradermal tissue and create the desired bleb. A 20 or 21 gauge needle is used for IM injections in which the medication is viscous. A 22 or 23 gauge needle is used for IM injections. The 25 or 26 gauge needle is used for subcutaneous injections.

A 65-year-old, 61-kg patient, is ready for her annual flu vaccine that is delivered intramuscularly. What size needle would the nurse use to administer this IM injection in the deltoid muscle of this patient?

25-gauge 1 inch needle

At what angle should a subcutaneous injection be delivered in an obese adult?

90 degrees

Why should the nurse avoid massaging the intradermal injection site?

Because it will disperse the medication into the underlying tissues

The nurse is preparing an IM injection from a liquid vial. The nurse has selected a 25-gauge, 1.5-inch needle, but is experiencing great difficulty withdrawing the fluid from the vial. The nurse notices that the solution in the vial is very thick. What should the nurse do?

Change needles and use a 21-gauge, 1.5-inch needle.

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

While preparing a subcutaneous injection, the nurse accidentally touches the tip of the syringe while attaching the needle. What should the nurse do?

Get a new sterile syringe.

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?

Give the morphine intramuscularly because this route will allow it to be absorbed more rapidly.

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

IM

The nurse just completed giving a patient an injection and turns to deposit the syringe and uncovered needle into the sharps container. Suddenly the patient's daughter runs between the nurse and the sharps container. The nurse stuck the child with the needle. What should the nurse do?

Notify the supervisor, who will be responsible for walking the mother and child through the clinic's needle-stick procedure.

Which of the following accurately describes how to locate the ventrogluteal site?

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. Correct

Before giving the patient an injection from a vial, the nurse changes needles. This is done to:

Provide a sharper needle for a less painful injection

After giving a subcutaneous injection of heparin, the nurse refrains from massaging the site so as to prevent:

Tissue damage

The nurse has to give a 1-month-old the hepatitis B vaccine. Which is the best site for administration?

Vastus lateralis

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?

Vastus lateralis muscle

The correct dosage is measured on a syringe:

Where the head of the plunger touches the sides of the barrel of the syringe

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?

Withdraw the needle and start over

The nurse is administering the flu vaccine to a patient. The nurse performs hand hygiene, locates the site and swabs it with alcohol. The nurse allows the alcohol to dry, uncaps the needle and administers the injection. The nurse disposes of the syringe and needle in the sharps container. Which of the following actions increased the risk for infection? The nurse:

failed to apply clean gloves after performing hand hygiene.

The nurse has the medication administration record, the vials of medication, alcohol swabs, and a medication label. Identify the remaining equipment needed to deliver a total volume of 1.4 mL IM injection to an average-size adult from two vials:

-Needle for withdrawing -Disposable gloves Correct -21- to 25-gauge needle -1 - 1.5" length needle -1 - 3" length needle

The nurse has the medication administration record, the ampule of medication, alcohol swabs, and a medication label. Identify the remaining equipment needed to deliver 0.6 mL of medication IM from an ampule:

-Filter needle -Disposable gloves Correct -21- to 25-gauge needle Correct -1 - 1.5" length needle Correct -1-mL syringe Corre

The nurse has the medication administration record, the vial of medication, alcohol swabs, and a medication label. Identify the remaining equipment needed to deliver 0.5 mL of medication subcutaneously from a liquid vial:

-Needle for withdrawing -25- to 27-gauge needle -Disposable gloves -3/8 - 5/8" length needle -1-mL syringe

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:

-Needle for withdrawing -Dilute -1- to 3-mL syringe -Disposable gloves -21- to 25-gauge needle -1 to 1.5 inch needle

The nurse prepares to administer a subcutaneous injection to a normal-size adult on the upper left arm. The nurse chooses a needle:

5/8 inch in length to insert at a 45-degree angle

The nurse has just given an intradermal injection; what does the nurse expect to see?

A raised, fluid-filled bleb resembling a mosquito bite

The nurse is giving a tuberculosis test injection; at what angle does the nurse insert the needle?

Bevel up, 5- to 15-degree angle

An 81-year-old cachetic woman (weighing 40 kg) requires iron dextran 1 mL intramuscularly. How will the nurse administer this injection?

Choose a 21-gauge, 0.5- to 1-inch needle and administer the injection with the Z-track technique at a 90-degree angle.

Why is a filter needle used to withdraw medication from an ampule?

It prevents entry of glass into the syringe.

Generally with a subcutaneous injection, medication absorption is _____________than that of an IM injection

Slower

The health care provider has ordered 20 mg furosemide (Lasix) IV now. The medication is available in an ampule. The nurse places a gauze pad around the neck of the ampule and snaps the neck of the ampule away from the nurse. The nurse places the top of the ampule in the sharps container and prepares to withdraw the medication using a filter needle. What step did the nurse forget? The nurse:

forgot to check that all medication is in the bottom part of the ampule prior to breaking.

When withdrawing medication from a vial, why is it important to first inject air into the vial?

prevents the buildup of negative pressure in the vial.