Ch 22 - Parenteral Medications
An injection that is given into the body of a muscle is known as an __________________ injection.
ANS: intramuscular (IM) An intramuscular (IM) injection is an injection into the body of a muscle.
_____________ syringes require special needles, which are twisted onto the tip and lock themselves in place.
ANS: Luer-Lok Luer-Lok syringes require special needles, which are twisted onto the tip and lock themselves in place. The design prevents the unintentional removal of the needle from the syringe. Non-Luer-Lok syringes use needles that slip onto the tip.
________________ administration of medication instills medications into body tissues and into the circulatory system by injection.
ANS: Parenteral The route of administration is the path by which a drug comes in contact with the body. Parenteral means taken into the body or administered in a manner other than through the digestive tract. Parenteral administration of medication instills medications into body tissues and into the circulatory system by injection.
The method of injecting a medication that requires pulling the skin laterally before injection is known as the ___________________.
ANS: Z-track method The Z-track technique, which pulls the skin laterally before injection, prevents leakage of medication into subcutaneous tissue, seals medication in the muscle, and minimizes irritation
An _______________ is made of glass with a constricted, prescored neck that needs to be snapped off to allow access to the medication.
ANS: ampule Ampules contain single doses of injectable medication in a liquid form and are available in sizes from 1 to 10 mL or more. An ampule is made of glass with a constricted, prescored neck that you need to snap off to allow access to the medication.
An IV __________ or "push" usually requires small volumes of fluid, which is an advantage for patients who are at risk for fluid overload.
ANS: bolus An IV bolus or "push" usually requires small volumes of fluid, which is an advantage for patients who are at risk for fluid overload.
A subcutaneous medication delivery system that allows for continuous administration of medication is known as ________________.
ANS: continuous subcutaneous infusion The continuous subcutaneous infusion route of medication administration is an alternative to IV, IM, or subcutaneous injection. The continuous subcutaneous infusion route is used for continuous administration of selected medications (e.g., opioids, insulin).
The nurse is preparing to draw up medication from an ampule. She realizes that she will need a _________________ to draw up the medication.
ANS: filter needle Aspiration of medication from the ampule is achieved with a filter needle and syringe. Filter needles prevent glass particles from being drawn into the syringe.
While checking the patient's intravenous (IV) site, the nurse notices that the site is cool, pale, and swollen. She immediately stops the IV infusion, realizing that these are signs indicating _____________.
ANS: infiltration The patient has an unexpected outcome when his intravenous site becomes cool, pale, and swollen, indicating infiltration
An ____________ injection is an injection into the dermis just under the epidermis.
ANS: intradermal (ID) An intradermal (ID) injection is an injection into the dermis just under the epidermis.
In a volume-controlled administration set, the nurse usually mixes medication with: a. 10 to 30 mL of solution b. 50 to 100 mL of solution c. 100 to 500 mL of solution d. 500 to 1000 mL of solution
ANS: B Fill Volutrol with the desired amount of IV fluid (50 to 100 mL) by opening the clamp between Volutrol and the main IV bag. IV medication is diluted with small fluid volume, which reduces the risk for rapid infusion.
Injection of a medication into a vein is known as an ________________injection or infusion.
ANS: intravenous (IV) An intravenous (IV) injection or infusion is an injection into a vein.
The most frequent route of exposure to blood-borne disease for health care workers is _________________.
ANS: needle stick injury The most frequent route of exposure to blood-borne disease for health care workers is needle stick injury
The patient is complaining of tenderness at his intravenous (IV) insertion site. The nurse examines the site and notices that the site is swollen, warm, and reddened. The nurse stops the intravenous infusion, realizing that the patient has ________________.
ANS: phlebitis The patient has an unexpected outcome when his intravenous site becomes swollen, warm, reddened, and tender to touch, indicating phlebitis.
A method of medication delivery that involves a small intravenous (IV) bag or bottle connected by a short tubing line connected to the upper Y-port of a primary infusion line is called a _____________ infusion.
ANS: piggyback A piggyback is a small (25 to 250 mL) IV bag or bottle connected to a short tubing line that connects to the upper Y-port of a primary infusion line (Figure 22-21) or to an intermittent venous access.
The dorsogluteal injection site should not be avoided in favor of the ventrogluteal site because of the risk of damaging the _______________.
ANS: sciatic nerve Recent evidence supports avoiding the traditional dorsogluteal route in favor of the ventrogluteal site. Therefore the dorsogluteal site should not be used as a site for IM injection. Studies have demonstrated that the exact location of the sciatic nerve varies from one person to another. If a needle hits the sciatic nerve, the patient may experience permanent or partial paralysis of the involved leg.
A _______________ injection is an injection into tissues just under the dermis of the skin.
ANS: subcutaneous A subcutaneous injection is an injection into tissues just under the dermis of the skin.
A ______________ is a small (25 to 250 mL) IV bag or bottle connected to a short tubing line to the lower Y-port of a primary infusion line or to an intermittent venous access.
ANS: tandem setup A tandem setup is a small (25 to 250 mL) IV bag or bottle connected to a short tubing line to the lower Y-port of a primary infusion line or to an intermittent venous access.
Research suggests that the _____________ area is the most appropriate site for all age groups of children receiving IM injections.
ANS: ventrogluteal Research suggests that the ventrogluteal area is the most appropriate site for all age-groups of children.
A single-dose or multidose container that contains a liquid or dry form of a medication and that has a rubber seal at the top is known as a ________________.
ANS: vial A vial is a single-dose or multidose container with a rubber seal at the top that is protected by a metal cap. Remove the metal cap when preparing the vial for use. Vials contain liquid or dry forms of medications. Medications that are unstable in solution are packaged dry
An intravenous (IV) administration set that attaches just below the primary infusion bag or bottle to control small volumes of fluid is known as a ________________.
ANS: volume control administration set Volume control administration sets (e.g., Volutrol, Buretrol, Pediatrol) are small (50 to 150 mL) containers that attach just below the primary infusion bag or bottle. The set is attached and is filled in a manner similar to that used with a regular IV infusion. However, the priming filling of the set is different, depending on the type of filter (floating valve or membrane) within the set. Follow package directions for priming sets.
A patient is demonstrating the technique for mixing regular and NPH insulins in the same syringe. A nurse evaluates that further instruction is required if the patient first: a. Aspirates and injects air equal to the regular insulin dose into the vial first and withdraws the regular insulin b. Aspirates and injects air equal to the NPH insulin into the vial but does not withdraw the medication c. Withdraws the proper amount of NPH insulin before withdrawing the regular insulin d. Calculates the combined total of insulin after withdrawing the NPH insulin
ANS: A If mixing rapid- or short-acting insulin with intermediate- or long-acting insulin, take insulin syringe and aspirate volume of air equivalent to dose to be withdrawn from intermediate- or long-acting insulin first.
An appropriate technique for administration of a parenteral medication is observed when the nurse: a. Uses strict aseptic technique b. Tightly holds the inside surface of the syringe plunger c. Injects medication as rapidly as possible d. Slowly inserts the needle through the patient's tissue
ANS: A Strict aseptic technique is used during all steps of preparation and administration of parenteral medications Touching the inside surface of the plunger should be avoided. Medication should be injected slowly and smoothly. The needle should be inserted smoothly and quickly.
Which syringe should the nurse select for an injection of 0.45 mL of medication to a pediatric patient? a. Tuberculin syringe b. Insulin syringe c. Low-dose insulin syringe d. 3-mL syringe
ANS: A The tuberculin syringe has a long, thin barrel with a preattached thin needle. The syringe is calibrated in sixteenths of a minim and hundredths of a milliliter and has a capacity of 1 mL. You use tuberculin syringes to prepare small amounts of medication, such as small, precise doses for infants or young children. You also use them for ID and subcutaneous injections. An insulin syringe is used to administer insulin. A low-dose insulin syringe is used to administer insulin. A syringe this large (3-mL) would not be used for the pediatric dose.
What does the nurse do to administer an intramuscular injection via the Z-track method? a. Pulls the skin tissue laterally 1 to 1½ inches b. Does not aspirate back on the syringe c. Immediately removes the needle after injecting the medication d. Releases the skin before removing the needle from the site
ANS: A To use the Z-track method, apply the appropriate size needle to the syringe, and select an IM site, preferably in a large, deep muscle, such as the ventrogluteal. Pull the overlying skin and subcutaneous tissues approximately 2.5 to 3.5 cm (1 to 1½ inches) laterally to the side with the ulnar side of the nondominant hand. Hold the skin in this position until you have administered the injection. After cleansing the site, inject the needle deeply into the muscle. If there is no blood return on aspiration, slowly inject the medication. Keep the needle inserted for 10 seconds to allow the medication to disperse evenly. Then release the skin after withdrawing the needle. This leaves a zigzag path that seals the needle track wherever tissue planes slide across each other. The medication is sealed in the muscle tissue.
The nurse is preparing to administer an intramuscular medication. In determining what size needle and syringe to use to administer the medication, the nurse must consider which of the following? (Select all that apply.) a. The quantity of medication b. The viscosity of the medication c. The body size of the patient d. Whether or not the syringe has a safety needle
ANS: A, B, C The nurse needs to determine the appropriate size of syringe, length and gauge of needle, volume of solution, and medication route. These decisions are based on the quantity and viscosity of medication to be delivered and the body size of the patient.
The nurse has a responsibility to ensure that every IM injection is given safely. In doing so, the nurse is trying to prevent which of the following? (Select all that apply.) a. Abscess formation b. Sciatic nerve injury c. Persistent pain d. Hematoma
ANS: A, B, C, D Complications from IM injections include abscess formation, sciatic nerve injury, local induration, erythema, persistent pain, hematoma, and bleeding.
Failure to inject a medication correctly may result in which of the following? (Select all that apply.) a. An inappropriate dug response b. Nerve injury and/or pain c. Tissue necrosis d. Sterile abscess
ANS: A, B, C, D Failure to inject a medication correctly will result in complications such as an inappropriate drug response (e.g., too rapid or too slow), nerve injury with associated pain, localized bleeding, tissue necrosis, and sterile abscess.
Why is the IV bolus considered a dangerous method by which to administer medications? (Select all that apply.) a. It does not allow time to correct errors b. It may be irritating to the lining of blood vessels c. It can cause pain and abscesses d. It can cause sloughing of tissues
ANS: A, B, C, D The IV bolus is a dangerous method by which to administer medications, because it allows no time to correct errors. Therefore, be very careful in calculating the correct amount of the medication to give. In addition, a bolus may cause direct irritation to the lining of blood vessels, so always confirm placement of the IV catheter or needle. Never give an IV bolus if the insertion site appears puffy, edematous, or reddened, or if the IV fluids do not flow at the ordered rate. Accidental injection of some medications into tissues surrounding a vein can cause pain, sloughing of tissues, and abscesses.
Which of the following methods is used to administer intravenous medications? (Select all that apply.) a. Piggyback infusion b. Volume control device c. Electronic infusion device d. Bolus injection
ANS: A, B, C, D You administer intravenous medications (1) as a mixture within large volumes of IV fluids, (2) by piggyback infusion of a solution containing the prescribed medication and a small volume of IV fluid through an adjoining container or existing IV line, (3) by a volume control device, in which a small container, holding 50 to 150 mL of fluid, is attached below the primary infusion bag, (4) by electronic infusion device, or (5) by injection of a bolus or small volume of medication through an existing IV infusion line or intermittent venous access (heparin or saline lock).
Which part of the syringe must be kept sterile at all times? (Select all that apply.) a. The needle hub b. The needle shaft c. The syringe outer barrel d. The needle bevel
ANS: A, B, D The needle hub, shaft, and bevel must remain sterile at all times.
A raised, hardened, red zone of 5 mm in diameter noted around an intradermal test site would be expected in a: a. Patient who has no known risk factors for TB b. Patient who has human immunodeficiency virus (HIV) c. Patient who is an injection drug user d. Patient who is employed in a high-risk setting
ANS: B A raised, reddened, or hard zone around the test site indicates sensitivity to the allergen or a positive tuberculin skin test. An induration that measures 5 mm or more in diameter indicates a positive TB reaction in patients who are human immunodeficiency virus (HIV) positive, have fibrotic changes on chest radiograph consistent with previous TB infection, have had organ transplants, or who are immunosuppressed. An induration of 15 mm or more indicates a positive reaction in TB patients with no known risk factors for TB. An induration of 10 mm or more indicates a positive TB reaction in patients who are recent immigrants; injection drug users; residents and employees in high-risk settings; patients with certain chronic illnesses; children younger than 4 years of age; and infants, children, and adolescents exposed to high-risk adults.
What instructions should the nurse give to the family member who is to administer a subcutaneous insulin injection for a patient? a. Massage the site after the injection. b. Select a 25-gauge, ½- to 5/8-inch needle. c. Insert the needle at a 45-degree angle if 2 inches of tissue can be pinched. d. Rotate injection site each time from one major site to another.
ANS: B Generally, a 25-gauge, 5/8-inch needle inserted at a 45-degree angle, or a ½-inch needle inserted at a 90-degree angle, deposits medications into the subcutaneous tissue of a normal-size patient. A child usually requires a 26- to 30-gauge, ½-inch needle inserted at a 90-degree angle. Massage can damage underlying tissue. The angle of insertion is 90 degrees for an obese patient. If you can grasp 2 inches (5 cm) of tissue, insert the needle at a 90-degree angle; if you can grasp 1 inch (2.5 cm) of tissue, insert the needle at a 45-degree angle. Injection site rotation is no longer necessary because newer human insulins carry a lower risk for hypertrophy. Patients choose one anatomical area (e.g., the abdomen) and systematically rotate sites within that region, which maintains consistent insulin absorption from day to day
When assessing a patient's IV insertion site, the nurse notes that it is warm, reddened, and tender. The nurse should first: a. Slow the infusion rate b. Discontinue the IV infusion c. Apply a local anesthetic d. Apply warm compresses
ANS: B The intravenous site becomes swollen, warm, reddened, and tender to touch, indicating phlebitis. Stop the IV infusion, discontinue the IV infusion, treat the IV site as indicated by institutional policy, and insert a new IV catheter if therapy continues.
The nurse prepares to administer an intradermal injection for the administration of medication for: a. Pain b. Allergy sensitivity c. Anticoagulant therapy d. Low-dose insulin requirements
ANS: B The nurse typically gives intradermal injections for skin testing, for example, in tuberculin screening and allergy tests. Pain medications are not administered intradermally. Anticoagulants are not administered intradermally. They typically are given subcutaneously. Intradermal injections are not used for low-dose insulin requirements.
The nurse is evaluating the integrity of the ventrogluteal injection site. The nurse finds the site by locating the: a. Middle third of the lateral thigh b. Greater trochanter, anterior iliac spine, and iliac crest c. Anterior aspect of the upper thigh d. Acromion process and axilla
ANS: B To locate the ventrogluteal muscle, place the heel of the hand over the greater trochanter of the patient's hip with the wrist almost perpendicular to the femur. Use the right hand for the left hip, and the left hand for the right hip. Point the thumb toward the patient's groin and the index finger toward the anterior superior iliac spine, and extend the middle finger back along the iliac crest toward the buttock. The index finger, the middle finger, and the iliac crest form a V-shaped triangle. The injection site is the center of the triangle. The vastus lateralis site is found by locating the middle third of the lateral thigh. The anterior aspect of the thigh may be used for subcutaneous injections; it is not how the ventrogluteal site is located. The acromion process and axilla may be used to locate the deltoid site
What are the anatomical landmarks for the ventrogluteal injection site? a. Greater trochanter and knee b. Anterosuperior iliac spine and iliac crest c. Posterior superior iliac spine and iliac crest d. Acromion process, scapula, and axilla
ANS: B To locate the ventrogluteal site, place the heel of the hand over the greater trochanter of the patient's hip with the wrist almost perpendicular to the femur. Use the right hand for the left hip, and the left hand for the right hip. Point the thumb toward the patient's groin and the index finger toward the anterosuperior iliac spine, and extend the middle finger back along the iliac crest toward the buttock. The index finger, the middle finger, and the iliac crest form a V-shaped triangle. The injection site is the center of the triangle.
Which of the following are acceptable sites for subcutaneous injections? (Select all that apply.) a. Dorsogluteal b. Upper arms c. Abdomen d. Thighs
ANS: B, C, D The best subcutaneous injection sites include the outer aspect of the upper arms, the abdomen from below the costal margins to the iliac crests, and the anterior aspects of the thighs. These areas are easily accessible and are large enough that you can rotate multiple injections within each anatomical location.
An appropriate maximum amount of medication that could be given intramuscularly to a normal, well-developed adult is: a. 2 mL b. 3 mL c. 5 mL d. 8 mL
ANS: C A normal, well-developed adult can safely tolerate 2 to 5 mL of medication in larger muscles such as the ventrogluteal. However, clinically, it is unusual to administer more than 3 ml of medication in a single injection because the body does not absorb it well. Elderly adults and thin patients often tolerate only 2 mL in a single injection.
The nurse is preparing to give an IM injection to a 6-month-old infant. Which site is the most appropriate for administration of the injection to this patient? a. The deltoid muscle b. The dorsogluteal injection site c. The vastus lateralis d. All of the above
ANS: C Based on the evidence, the recommendation for pediatric IM injection sites includes use of the vastus lateralis for infants up to 12 months of age, the deltoid in children 12 months and older, and the ventrogluteal site for children of all ages. The deltoid muscle is an acceptable site only in children 12 months and older. The dorsogluteal site should not be used as a site for IM injection.
The nurse is preparing to administer the long-acting insulin glargine (Lantus) as well as Regular insulin to a patient. The nurse realizes that she should: a. Inject air into the Lantus first and not withdraw medication b. Inject air into the Regular insulin first and then into the Lantus c. Use two needles d. Inject air into the Lantus first and withdraw the Regular
ANS: C If long-acting insulin glargine (Lantus) is ordered, note that this is a clear insulin that should not be mixed with other insulin preparations.
The nurse is preparing to administer an immunization to a toddler. The preferred site for administration of immunizations in this age group is the: a. Deltoid muscle b. Dorsogluteal muscle c. Vastus lateralis muscle d. Buttock
ANS: C The vastus lateralis muscle is the preferred site for administration of biologicals (e.g., immunizations) to infants, toddlers, and children. The dorsogluteal (buttock) is no longer a recommended injection site. There is potential for injury at the deltoid because the axillary, radial, brachial, and ulnar nerves and the brachial artery lie within the upper arm under the triceps and along the humerus. Use this site for small medication volumes (0.5 to 1 ml), for administration of routine immunizations to toddlers, older children, and adults, or when other sites are inaccessible because of dressings or casts.
What is the appropriate technique for the nurse to use to remove medication from an ampule? a. Keep the needle against the rim of the ampule b. Break the neck of the ampule toward the hands c. Tip the ampule to bring all fluid within reach of the needle d. Add a volume of air to push the medication out into the syringe
ANS: C Keep the needle tip under the surface of the fluid and tip the ampule so that all the fluid is within reach, to prevent aspiration of air. The broken rim of the ampule is considered contaminated. When the ampule is inverted, the solution can drip out of the ampule if the needle touches the rim of the ampule. The ampule should be broken away from the hands to avoid injury to the nurse. Air should not be added to the ampule; increasing air pressure may force fluid out of the ampule.
What is an advantage of providing medication via intravenous bolus? a. A slow onset of medication effects b. Medications can be given over a longer time frame c. Medications provide a more accurate dose of medication delivered d. Hypersensitivity reactions are always delayed
ANS: C Medications provide delivery of a more accurate dose of medication because no medication is left in the IV tubing. With IV bolus medications, rapid onset of medication effects occurs, which is useful for patients who are experiencing critical or emergent health problems. Medications can be prepared quickly and given over a shorter time frame than by IV piggyback. Hypersensitivity reaction can cause an immediate or delayed systemic reaction to a medication, requiring supportive measures.
The nurse is preparing to administer an intravenous (IV) antibiotic using a tandem setup. The nurse must: a. Connect the tubing to the upper Y-port of the primary infusion line b. Hang the antibiotic at a higher level than the main IV bag c. Monitor the tandem setup closely d. Be sure that the primary line is not running while the antibiotic is running
ANS: C Monitor the tandem setup closely. If the tandem setup is not clamped immediately when the medication is infused, the IV solution from the primary line will back up into the tandem line. A tandem setup is a small (25 to 250 mL) IV bag or bottle connected to a short tubing line to the lower Y-port of a primary infusion line, or to an intermittent venous access. You place the tandem set at the same height as the primary infusion bag or bottle. In the tandem setup, the tandem and the main line infuse simultaneously.
To administer an injection intradermally, the nurse should: a. Use a tuberculin or small syringe with a 1-inch needle b. Inject no more than 1 mL of solution c. Insert the needle at a 5- to 15-degree angle d. Expect a small amount of bleeding after injection
ANS: C The angle of insertion for an intradermal injection is 5 to 15 degrees. To administer an injection intradermally, use a tuberculin or small syringe with a short, fine-gauge (25 to 27) needle. You inject only small amounts of medication (0.01 to 0.1 mL) intradermally. If a bleb does not appear, or if the site bleeds after needle withdrawal, the medication may have entered subcutaneous tissue. In this situation, skin test results will not be valid.
The nurse administers the intramuscular medication of iron by the Z-track method. Why was the medication administered by this method? (Select all that apply.) a. Provides faster absorption of the medication b. Reduces discomfort from the needle c. Prevents leakage of medication into subcutaneous tissue d. Prevents the drug from irritating sensitive tissue
ANS: C, D The Z-track method is recommended for IM injections. The Z-track technique, which pulls the skin laterally before injection, prevents leakage of medication into subcutaneous tissue, seals medication in the muscle, and minimizes irritation.
The nurse is preparing to start an infusion of ciprofloxacin to run as a piggyback infusion. For the system to run properly, the nurse must: a. Hang the bag lower than the primary infusion b. Stop the primary bag from running so the piggyback can run c. Plug the piggyback into the lowest port on the primary bag's tubing d. Connect the bag to the upper Y-port of a primary infusion line
ANS: D A piggyback is a small (25 to 250 mL) IV bag or bottle connected to a short tubing line that connects to the upper Y-port of a primary infusion line or to an intermittent venous access. The set is called a "piggyback" because the small bag or bottle is set higher than the primary infusion bag or bottle. In the piggyback setup, the main line does not infuse when a compatible piggybacked medication is infusing. The port of the primary IV line contains a back-check valve that automatically stops the flow of the primary infusion once the piggyback infusion flows. After the piggyback solution infuses and the solution within the tubing falls below the level of the primary infusion drip chamber, the back-check valve opens, and the primary infusion starts to flow again.
Intradermal injections are administered correctly when the nurse: a. Uses a 1-inch needle b. Selects a 22-gauge needle c. Injects at a 45-degree angle d. Identifies the site at 3 fingerwidths below the antecubital space
ANS: D A site that is 3 to 4 fingerwidths below the antecubital space and 1 handwidth above the wrist and is free of bruises, inflammation, or edema is selected for intradermal injection. To administer an injection intradermally, use a tuberculin or small syringe with a short, fine-gauge (25 to 27) needle. The angle of insertion for an intradermal injection is 5 to 15 degrees.
The nurse has drawn up Regular and NPH insulin for administration to her diabetic patient. When the nurse enters the room, the patient has gone to radiology for a chest radiograph and will return in 20 minutes. What should the nurse do with the medication? a. Put the medication in the refrigerator until he returns b. Put the medication in the patient's medication box until he returns c. Keep the syringe in her pocket until he returns d. Discard the medication and withdraw more when he returns
ANS: D Administer mixture of insulin within 5 minutes of preparation. Rapid- or short-acting insulin can bind with intermediate- or long-acting insulin, thus reducing the action of the more rapid-acting insulin
After insertion of the needle into a patient's tissue, a nurse aspirates and notices a very small amount of blood return. What should the nurse do? a. Continue with the injection b. Discontinue the procedure and notify the nurse in charge c. Remove and change the needle, and then readminister the medication d. Discontinue the procedure and repeat the entire preparation of the medication
ANS: D Aspiration of blood indicates intravenous placement of the needle. Immediately stop the injection, remove the needle, and prepare a new syringe of medication for administration.
When preparing to administer an IV bolus medication with a small-gauge needle, the nurse notes that there is no blood return on aspiration. What should the nurse do? a. Discontinue the procedure and inform the physician b. Select a different site and start a new IV c. Notify the pharmacy d. Determine the presence of an infiltration
ANS: D In some cases, especially with a smaller-gauge IV needle, blood return is not always aspirated, even if the IV is patent. Confirm patency. If the IV site does not show signs of infiltration, and if the IV fluid is infusing without difficulty, proceed with IV push. Discontinue the line and start a new one only if the line is not patent. There is no need to notify the physician unless a new line cannot be started and therapy will be disrupted. There is no need to notify the pharmacy.
An appropriate technique for the nurse to implement for a patient with a continuous subcutaneous infusion is to: a. Change the site every day b. Use a gauze dressing over the insertion site c. Select an insertion site over a bony prominence d. Insert the packaged needle at a 90-degree angle, or according to direction.
ANS: D Some prepackaged needles (e.g., Sof-Set, Sub-Q-Set) are inserted at a 90-degree angle. These needles are shorter than butterfly needles. Refer to the manufacturer's directions. The site is changed every 72 hours, according to policy or when complications occur. An occlusive transparent dressing is used over the site. Sites away from bony prominences are chosen.
The nurse is teaching the patient how to prepare 10 units of Regular insulin and 5 units of NPH insulin for injection. What should the nurse instruct the patient to do? a. Inject air into the Regular insulin, then into the NPH b. Withdraw the Regular insulin before injecting the air c. Inject air into and withdraw the NPH immediately d. Inject air into both vials and withdraw the Regular insulin first
ANS: D The patient should be taught to inject air into both vials and to withdraw the Regular insulin first. Air should be injected into the vial of NPH insulin, and then into the vial of Regular insulin. The Regular insulin should be withdrawn after air has been injected into both vials
The patient is to receive low-molecular-weight heparin by injection. Where on the patient's anatomy should the nurse prepare to inject this medication? a. Scapular region b. Vastus lateralis c. Posterior gluteal d. Abdomen
ANS: D To minimize the pain and bruising associated with low-molecular-weight heparin, it is given subcutaneously on the right or left side of the abdomen, at least 2 inches away from the umbilicus; this area is commonly referred to as a patient's "love handles." The scapular area may be used for subcutaneous injection, but it is not a recommended site for heparin injection. The vastus lateralis is used for intramuscular injection, not for subcutaneous injection. The posterior gluteal site is not recommended for heparin injection
To add medication to the intravenous (IV) fluid bag, the nurse should: a. Shake the bag vigorously to mix the medication b. Insert medication into the main tubing port c. Label the outside of the bag with a felt-tip marker d. Cleanse the injection port with antiseptic before adding the medication.
ANS: D Wipe off the port or injection site with alcohol or antiseptic swab to reduce the risk of introducing microorganisms into the bag during needle insertion. The bag is mixed gently rather than shaken. The medication injection port is used to add medication. A medication label is used to indicate what has been added; ink used on a plastic IV bag can penetrate the plastic and leak into the IV solution.