Assignment 22 Medication Administration Part 2: Parenteral Medications

The nurse is preparing to reinforce teaching to a patient diagnosed with diabetes mellitus. The nurse selects a syringe that holds a total volume of 0.3 mL. For which patient would this syringe be inappropriate? 1. An adult patient requiring 100 units of insulin each morning 2. An older adult patient who struggles to read the calibrations on a syringe 3. A school-age patient who will self-administer insulin doses 4. A patient who is ordered to take small amounts of insulin coverage during the day

1. An adult patient requiring 100 units of insulin each morning Option 1: The insulin syringe best suited for a patient who needs 100 units of insulin each morning is the standard 1 mL syringe, which holds up to 100 units of insulin.

The nurse is always conscious of ways to prevent complications related to IM injections. Which actions by the nurse are effective in preventing infections? Select all that apply. 1. Cleanse the injection site thoroughly. 2. Cover the injection site with a bandage. 3. Properly perform hand hygiene. 4. Encourage relaxation of the injection site. 5. Assist to a position that exposes the injection site.

1. Cleanse the injection site thoroughly. 2. Cover the injection site with a bandage. 3. Properly perform hand hygiene. Option 1: The injection site is cleansed thoroughly to prevent an infection. A two-inch-wide area is cleaned in concentric circles from the center out. An alcohol wipe or facility-approved antiseptic is used. Option 2: In order to prevent infection, the puncture wound from an injection is covered with a bandage to allow time for the skin to seal over. Option 3: Good hand hygiene by the nurse is always the first line of infection prevention. The hands are cleaned before and after administering an IM injection.

The nurse is reviewing the health-care provider's order for an IM medication for an adult. The patient is a young adult with well-developed muscles. When the nurse draws up the medication the volume is 3.5 mL. Which action does the nurse take? 1. Divide the dose and give two injections. 2. Contact the health-care provider for a change of order. 3. Give the injection in the ventrogluteal site. 4. Encourage ambulation to promote absorption.

1. Divide the dose and give two injections. Option 1: The nurse divides the volume of medication into two smaller amounts and gives two injections in two different locations.

The nurse is accidentally stuck with a needle following the administration of an IM medication. Which actions does the nurse perform? Select all that apply. 1. Document the incidence. 2. Undergo follow-up testing at specified intervals. 3. Immediately wash the puncture site with soap and water. 4. Seek medical attention only if site becomes infected. 5. Follow facility protocol.

1. Document the incidence. 2. Undergo follow-up testing at specified intervals. 3. Immediately wash the puncture site with soap and water. 5. Follow facility protocol. Option 1: The nurse needs to document the incident according to facility protocol. The incident report will be examined to determine how to prevent future needle sticks. Option 2: The nurse will be required to have follow-up testing at specified intervals. Option 3: Washing the puncture site will encourage bleeding and decrease the amount of pathogens at the site. Option 5: The nurse will need to follow facility protocol, which may include notifying certain parties and filling out incident reports.

The nurse is preparing an IM injection for a patient. The health-care provider's order is filled with a medication that requires a volume of 2.5 mL. In which manner will the nurse administer the medication? 1. In a well-developed vastus lateralis muscle of an adult 2. In the ventral gluteal muscle of an athletic adolescent 3. In the gluteus minimus muscle of a healthy older adult 4. In the deltoid muscle for a well-developed older adult

1. In a well-developed vastus lateralis muscle of an adult Option 1: The vastus lateralis muscle is used for an IM injection volume between 2 and 3 mL. The muscle must be well developed or the gluteus maximus is used.

The nurse works in an acute care facility that most commonly administers pain medication by a parenteral route. Which reason for parenteral medication is positive? 1. It bypasses the gastrointestinal tract. 2. It requires additional supplies and equipment. 3. It is invasive and uncomfortable to the patient. 4. It requires qualified personnel for administration.

1. It bypasses the gastrointestinal tract. Option 1: When medication is given parenterally, the gastrointestinal tract is by bypassed and gastrointestinal irritation is avoided.

The nurse manager in a long-term care facility is concerned about the amount of medication errors that occur in the facility. Which feedback from the nurses indicate the most likely cause of the errors? 1. Patients want to be social around the medication cart. 2. The Medication Administration Record (MAR) lists the medications by generic and brand-names. 3. Patient pictures attached to the MAR are used for identification. 4. Patients need to be located before medications are given.

1. Patients want to be social around the medication cart. Option 1: Interruptions or an inability to concentrate on medication administration is a common cause of errors.

The nurse is providing care for a patient and receives an order to administer a subcutaneous (subcut) medication to the patient. Which actions will the nurse take prior to administering the medication? Select all that apply. 1. Review the patient\"s age and size. 2. Ascertain if the patient feels a need for the medication. 3. Determine the volume of medication to be drawn up. 4. Recall the amount of subcutaneous tissue at the site. 5. Select the appropriate gauge and length of needle.

1. Review the patient\"s age and size. 3. Determine the volume of medication to be drawn up. 4. Recall the amount of subcutaneous tissue at the site. 5. Select the appropriate gauge and length of needle. Option 1: The nurse will mentally review the patient\"s age and size, both of which will impact the location and type of needle needed for the injection. Option 3: The nurse will be able to determine the volume of medication to be drawn up by reviewing the order and examining the medication. Option 4: The nurse can mentally recall the amount of subcutaneous tissue at the selected site. Option 5: Based on the route, the medication, and characteristics of the patient, the nurse will select the appropriate gauge and length of the needle.

The nurse is preparing to administer insulin to a patient. The medication order involves a mixture of regular and NPH insulins. Which process is most important for the nurse to remember? 1. The clear insulin is drawn up first and then the cloudy. 2. Warm both of the insulins before they are given. 3. Air is injected into the vial of clear insulin first. 4. Two needles must be used to insert air into the vials.

1. The clear insulin is drawn up first and then the cloudy. Option 1: The correct order is always to draw up the clear insulin before drawing up the cloudy insulin. This prevents contamination of the clear insulin with the cloudy, which is longer acting.

The nurse receives a health-care provider's order to administer an injectable medication to a patient. The vial of medication needs reconstituted. Which reason for reconstitution does the nurse apply to the medication? 1. The medication is unstable in a liquid form. 2. The medication has a longer shelf life as powder. 3. The liquid can be tailored to the patient\"s need. 4. The liquid form is more expensive to buy.

1. The medication is unstable in a liquid form. Option 1: The reason some medications need to be reconstituted is because the liquid from is stable for a limited or short period of time.

The nurse works in an acute care setting and is frequently administering parenteral medications to patients. Which factors will assist the nurse in selecting the correct gauge needle? Select all that apply. 1. The type and location of the injection 2. The overall size and muscle mass of the patient 3. The number of injections the patient has received 4. The viscosity of the medication being administered 5. The irritating characteristics of the medication

1. The type and location of the injection 2. The overall size and muscle mass of the patient 4. The viscosity of the medication being administered Option 1: The type and location of the injection plays an enormous part in selecting the needle gauge. Smaller-gauge needles are used for intradermal and subcutaneous injections, and larger gauge needles are used for intramuscular injections , Option 2: The overall size and muscle mass of the patient influences the nurse in selecting the needle gauge for an injection. Larger-gauge needles are needed for patients with large, dense muscles in order to prevent the needle from bending. Option 4: The viscosity of the medication directly affects the needle gauge selected by the nurse. Thicker medications require a larger-bore (smaller gauge) needle.

he nurse is preparing to administer subcutaneous medication supplied in an ampule. Which is the most important action for the nurse to remember for this procedure? 1. To withdraw medication from the ampule with a filter needle 2. To avoid injecting air into the upside-down ampule 3. To clean the neck of the ampule with an alcohol pad 4. To break the top of the ampule off directed away from the nurse

1. To withdraw medication from the ampule with a filter needle Option 1: Because of the possibility of tiny glass particles getting into the ampule when the top is snapped off, a filter needle is used to withdraw medication from an ampule

The nurse is preparing to draw up medication from a vial. Which steps will the nurse perform to correctly complete this task? Select all that apply. 1. Use the dominant hand to hold the flange of the plunger. 2. Pierce the stopper on the medication vial. 3. Shake the vial to thoroughly mix the medication. 4. Fill the syringe with air in an equal amount to the volume of medication. 5. Invert the vial and syringe and slowly pull back the plunger.

1. Use the dominant hand to hold the flange of the plunger. 2. Pierce the stopper on the medication vial. 4. Fill the syringe with air in an equal amount to the volume of medication. 5. Invert the vial and syringe and slowly pull back the plunger. Option 1: The nurse always uses the dominate hand to pull back the plunger. Only the flange of the plunger is touched to prevent the transfer of pathogens into the medication and/or the patient. Option 2: Vials are sealed with a rubber stopper that must be pierced by a needle to obtain the medication. Option 4: The syringe is filled with air in an equal amount to the volume of medication. The air is then injected into the vial and forms a sort of vacuum that makes filling the syringe with medication easier. Option 5: The medication is drawn up by inverting the vial and syringe together and slowly pulling the plunger back by the flange.

The nurse manager is concerned about an increasing number of needle sticks to nurses after administering injectable medications. Which instruction is the safest for the nurse manager to reinforce to the nursing staff? 1. Place the needle cap next to the patient so that it is easily scooped up after the injection. 2. Activate the needle safety guard as soon as the tip of the needle leaves the patient's skin. 3. Hold the needle cap while steadying the elbow on a solid surface to prevent shaking. 4. Approach the sharps container, snap off the needle, and drop the needle and syringe inside.

2. Activate the needle safety guard as soon as the tip of the needle leaves the patient's skin. Option 2: The safest way to prevent needle sticks is to activate the needle safety guard as soon as the tip of the needle leaves the patient's skin.

A nurse realizes he has administered the wrong medication to a patient. Which action will the nurse take immediately? 1. Call the patient's health-care provider to report a medication error. 2. Check the vital signs and status of the patient who received the wrong medications. 3. Fill out an incident report, providing the details of the error and the patient's condition. 4. Monitor the patient medicated in error closely and give the medications to the right patient.

2. Check the vital signs and status of the patient who received the wrong medications. Option 2: The nurse's first concern is for the well-being of the patient who received the wrong medication. The nurse will need to attend to the patient's safety immediately.

The nurse reviews a medication order for a patient. The order is for two drugs to be mixed and given intramuscular (IM). The nurse is concerned about drug incompatibility. Which action does the nurse take? 1. Mixes and gives the drugs as prescribed. 2. Consults with a pharmacist about compatibility. 3. Mixes the drugs and watches for physical changes. 4. Consults with the health-care provider about mixing the drugs.

2. Consults with a pharmacist about compatibility. Option 2: The nurse should consult with a pharmacist before mixing and giving the drugs. The pharmacist can use multiple resources if needed to validate the safety of mixing the two drugs.

The nurse is preparing to administer heparin to a patient. The prescription states that 1 mL of 10,000 units/mL heparin is to be administered subcutaneously (subcut). Which action by the nurse is incorrect? 1. Withdraw the needle after 10 sec. 2. Gently massage the area after the injection. 3. Check the amount of medication with another nurse. 4. Monitor previous laboratory results prior to administration.

2. Gently massage the area after the injection. Option 2: The site of heparin administration is not rubbed in any manner after the injection. Massage will cause bruising or hemorrhage.

The nurse is preparing to administer medication intramuscularly, and selects the correct size of syringe and needle. Which method will the nurse use to attach the needle to the syringe and keep the needle sterile? 1. Touch only the needle hub during attachment. 2. Hold the needle by the plastic cover during attachment. 3. Keep the needle in the package until it is attached to the syringe. 4. Wear sterile gloves until the hub is firmly attached to the syringe.

2. Hold the needle by the plastic cover during attachment. Option 2: Needles are covered with a hard plastic cover, which does not need to remain sterile. Holding the needle by the cover provides control during attachment and keeps the needle covered and sterile until needed.

The nurse is providing care for a patient who is ordered medication packaged in an ampule. After the nurse has drawn up the medication, which action will the nurse perform next? 1. Recap the filter needle using aseptic technique. 2. Replace the filter needle with a regular needle. 3. Examine the medication for glass shards. 4. Inject the medication according to the order.

2. Replace the filter needle with a regular needle. Option 2: The filter needle will need to be replaced with a regular needle. The filter needle is used to trap tiny glass particles from the ampule. The filter cannot be used for injection.

The nurse educator in an acute care facility is planning to introduce new research regarding the administration of intramuscular (IM) medications. Which factor does the nurse educator plan to emphasize? 1. Evidence shows that all IM injections should be aspirated prior to administration. 2. The Centers for Disease Control (CDC) recommends not aspirating IM and subcut immunizations and vaccines. 3. Research evidence indicates the neural and vascular structures are often hit with an IM injection. 4. The CDC recommends that subcut injections should always be aspirated.

2. The Centers for Disease Control (CDC) recommends not aspirating IM and subcut immunizations and vaccines. Option 2: The CDC and the Advisory Committee on Immunization Practices (ACIP) recommend that IM and subcut immunizations and vaccines not be aspirated in the acute setting.

The nurse is aware that a needle used for medication administration always has a slanted end called a bevel. The nurse is able to determine that which reason for a bevel on the tip of a needle is least likely? 1. The bevel prevents coring of tissue when the needle is inserted in the body. 2. The bevel is visible assurance to the nurse that the needle is sharp. 3. The bevel enables the drawing up of medication without foreign material contamination. 4. The bevel tip opens the skin and then allows a gradual increase in the skin-opening size.

2. The bevel is visible assurance to the nurse that the needle is sharp. Option 2: Pointed needles and blunt needles used for acquiring biopsy tissue do not have a bevel but are sharp. This is the least likely reason for a needle to have a bevel.

The nurse is preparing to administer a subcutaneous (subcut) injection. The nurse understands that which factors impact the decision for a subcut medication? Select all that apply. 1. The unavailability of the same medication for oral administration. 2. The need for slow and continuous absorption of the prescribed medication. 3. The volume of the drug exceeds the recommended maximum volume. 4. The body composition of the patient prescribed to receive the medication. 5. The medication must be isotonic and have the same pH as the tissue.

2. The need for slow and continuous absorption of the prescribed medication. 5. The medication must be isotonic and have the same pH as the tissue. Option 2: The subcut medication is prescribed when a slow and continuous absorption is needed; examples include insulin and anticoagulants. Option 5: In order to prevent tissue irritation and damage, the selected medications for subcut administration must be isotonic and have the same pH as the injected tissue.

The nurse asks a colleague to get a syringe for the administration of an intramuscular injection. Which piece of equipment should the nurse expect to be missing? 1. The barrel 2. The needle 3. The plunger 4. The tip

2. The needle

The nurse is very conscientious about administering IM medications with the least amount of discomfort and trauma to the patient. Which patient represents the biggest challenge to the nurse's goals? 1. The older adult. 2. The obese patient. 3. The young patient. 4. The sickest patient.

2. The obese patient. Option 2: The obese patient represents the biggest challenge to the nurse\"s goals. The issue is related to the difficulty the nurse may experience in identifying landmarks when selecting the injection site. Being 1 in. off can involve nerves and blood vessels.

The nurse works in a pediatric clinic and is responsible for administering medication prescribed by the health-care provider. The facility policy states to give IM injections in the ventrogluteal muscle for patients over the age of seven months. For which reason is this site used? 1. The site is well padded with subcutaneous tissue. 2. The site avoids major blood vessels and nerves. 3. The site is more easily accessed on all patients. 4. The site is accessible with the patient supine.

2. The site avoids major blood vessels and nerves. Option 2: The ventrogluteal muscle lies in an area without major blood vessels and nerves; the patient is less likely to be injured.

The nurse is preparing to administer a dose of viscus medication IM to a patient. The patient is a muscular male. Which needle does the nurse select? 1. A 24-gauge needle due to the thickness of the medication 2. A 14-gauge needle in order to easily penetrate the muscle 3. A 20-gauge needle to accommodate the medication and location of the IM 4. A 27-gauge needle to allow for rapid instillation of the medication

3. A 20-gauge needle to accommodate the medication and location of the IM Option 3: A 20-gauge needle is has a diameter adequate to inject a viscus medication and is strong enough to pierce a large muscle.

The nurse is preparing an injectable medication. The nurse selects the appropriate syringe and needle. Which action by the nurse will maintain sterility of the needle and syringe? 1. Opening the needle while holding the syringe. 2. Wearing sterile gloves when handling both objects. 3. Leaving the syringe on the open sterile package. 4. Holding the needle while opening the syringe package.

3. Leaving the syringe on the open sterile package. Option 3: Leaving the syringe on the open sterile package will prevent contamination of the syringe tip, which would contaminate inside of the needle hub when it is attached.

The nurse works on a unit where patients frequently require medication injections. Facility policy dictates that medications are prepared in the medication room. Which method will the nurse use to get a prepared injection safely to a patient? 1. Carry the uncapped needle to the patient's room. 2. Place the uncapped needle on a clean medicine tray. 3. Recap the needle using a one-hand scoop method. 4. Hold a paper towel as a shield for the uncapped needle.

3. Recap the needle using a one-hand scoop method. Option 3: In this scenario, the only way the nurse can get the injection safely to the patient is to use a one-hand scoop method to recap the needle before leaving the medicine room.

The nurse is preparing to administer an IM medication using the Z-track technique. For which medication is this technique inappropriate? 1. Medications that are irritating to subcutaneous tissues. 2. Dark-colored medications that can stain the skin. 3. The administration of heparin or insulin medications. 4. When it is important for the medication to remain in the muscle.

3. The administration of heparin or insulin medications. Option 3: The administration of heparin or insulin is never administered using the Z-track method, which would cause bruising or hemorrhage. The question specifically addresses IM medication.

The nurse is preparing to administer an intramuscular (IM) injection to a patient. Which information will assist the nurse in selecting the correct syringe size? 1. The consistency of the medication to be injected. 2. The dosage amount of the medication to be given. 3. The volume of medication that will be drawn up. 4. The physical size of the patient getting the medication.

3. The volume of medication that will be drawn up. Option 3: The volume of the medication that will be drawn up impacts the size of the syringe that is needed. The syringe size used for injections are most commonly 1, 3, or 5 mL.

The nurse is participating in a health fair and is performing tuberculosis (TB) tests. The nurse recognizes which indication the intradermal injection is being performed correctly? 1. The patient experiences pain with injection. 2. Bruising occurs as the needle is withdrawn. 3. The patient reports burning an itching at the site. 4. A wheal appears as the medication is injected.

4. A wheal appears as the medication is injected. Option 4: If a wheal appears as the medication is injected, the technique is correct. If a wheal does not appear when the medication is first injected, the nurse can gently lift up on the needle to verify intradermal placement.

The nurse is preparing a 2.25-mL injection for an adolescent. A patient insists the injection be given in the arm. Which action does the nurse take? 1. Ask the patient to select a second site choice. 2. Tell the patient the gluteus maximus is best. 3. Give the medication as the patient requests. 4. Explain that the volume of medication is too large.

4. Explain that the volume of medication is too large. Option 4: The nurse needs to explain to the patient that the volume of medication is too large for the deltoid muscle. The nurse can suggest the vastus lateralis or the ventrogluteal muscle and can let the patient choose.

The nurse is preparing to administer an anticoagulant to a patient by a subcutaneous (subcut) injection. Which action is important for the nurse to perform? 1. Aspirate before injecting the medication. 2. Administer the drug in the anterior thigh. 3. Massage the site after withdrawing the needle. 4. Pinch up tissue 3 in. from the umbilicus.

4. Pinch up tissue 3 in. from the umbilicus. Option 4: The location on the abdomen is a minimum of 1 to 2 in. away from the umbilicus. Pinching up the tissue separates it from the muscle and assures a subcut injection.

The nurse needs to recap a sterile needle so that medication can be safely transported to a patient's room. The nurse will use the one-hand scoop method of recapping. Which is the safest method of performing this task? 1. Place the needle cap on a level surface cleaned by alcohol. 2. Place the open end of the needle cap off the edge of a flat surface. 3. Position the needle cap propped at a 45-degree angle. 4. Position the open end of the needle cap in the center of an alcohol pad.

4. Position the open end of the needle cap in the center of an alcohol pad. Option 4: Positioning the open end of the needle cap in the center of an alcohol pad is the safest method for performing a one-hand scoop. The alcohol keeps the opening of the cap sterile, and pad anchors the cap so that rolling is unlikely.

The nurse is preparing to administer an IM to an adult patient, and needs to select the correct length of needle. Which factor will indicate the necessity for a longer needle length? 1. The age of the patient. 2. The gender of the patient 3. The medication ordered for the patient 4. The amount of subcutaneous fat on the patient

4. The amount of subcutaneous fat on the patient Option 4: If the medication is ordered IM, the amount of subcutaneous fat on the patient will determine the length of needle needed. The nurse needs to make sure the medication is injected into muscle tissue

The nurse manager emphasizes medication safety techniques with the nursing staff. For which reason does the nurse manager focus on injectable medications? 1. Medication by this route is stronger. 2. The route increases the rate of onset. 3. Injectable routes causes increased intensity. 4. The medication is immediately irretrievable.

4. The medication is immediately irretrievable. Option 4: A major reason for emphasizing the importance of safety techniques with injectable medications is because they are immediately irretrievable.

The nurse is planning to administer a parenteral medication and selects a tuberculin syringe. Besides performing an intradermal tuberculosis (TB) test, for which reason will the nurse select this size syringe? 1. To give an IM to a thin, older adult patient. 2. To administer insulin to a school-age patient 3. To administer eye medications to an adult patient 4. To give a precise amount of medication to a newborn

4. To give a precise amount of medication to a newborn Option 4: Tuberculin syringes hold a maximum of 1 mL and are calibrated to tenths and hundredths of a milliliter, down to sixteenths of a minim. This syringe is well suited to give small, precise amounts of medication to newborns and infants

The nurse works in an office where allergy testing occurs frequently. The nurse uses the intradermal injection skill to perform the testing. Which action does the nurse take if a drop of blood leaks from the puncture site when the needle is withdrawn? 1. Applies pressure to the bleb site to control the bleeding. 2. Presses only on the site of the leaking to preserve the bleb. 3. Ignores the bleeding and continues with the testing process. 4. Touches an alcohol swab or dry cotton ball to the blood to absorb it.

4. Touches an alcohol swab or dry cotton ball to the blood to absorb it. Option 4: Touching an alcohol swab or dry cotton ball gently to the blood will absorb the blood and not disturb the bleb.