Module 7
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? (Select all that apply.)
"A fast injection rate of the medication reduces pain and tissue trauma." "The needle should be removed after the skin is released."
Which of the following are correct statements you need to remember for safely administering an IM injection? (Select all that apply.)
-Check the patient's name band and ask the patient to tell you his or her name -Check the patient's allergies. -Wear clean gloves when administering the medication.
Match the information required for labeling a reconstituted powder vial to the descriptions. -Medication and initials missing -Diluent and concentration missing -Date and time missing -Complete
-Date: 12/15Time: 1200Diluent: bacteriostatic water for injectionConcentration: 2.2 mL = 1 g -Date: 04/07Time: 1000Medication: ticarcillinInitials: LT -Diluent: Bacteriostatic water for injectionMedication: penicillin G potassiumConcentration: 3.2 mL = 1,000,000 units penicillin G potassiumInitials: JB -Date: 02/12Time: 0600Diluent: sodium chloride for injectionMedication: StaphcillinConcentration: 2 mL = 1 g Staphcillin Initials: BC
The nurse is preparing the following order for administration:Morphine sulfate 7 mg and hydroxyzine hydrochloride (Vistaril) 25 mg IM postoperatively. The Morphine sulfate label states 1 mL=10 mg. The Vistaril label states 1 mL=50 mg.The nurse obtains the MAR, clean gloves, alcohol swabs, a 1 mL syringe, and a 1.5 inch 22 gauge needle. The nurse wipes the top of both vials with an alcohol swab, inserts the needle, injects the air into each vial, and withdraws the medication from the first vial. The nurse keeps the needle in the vial and taps on the syringe to remove any air bubbles. While the vial is inverted the nurse s finger touches the needle shaft. The nurse withdraws the needle from the vial and inserts it into the second vial and withdraws the correct amount of medication. The nurse uses the one-handed scoop method to recap the needle and labels the syringe before going to the patient s room. The nurse uses two patient identifiers to identify the correct patient. The nurse locates the ventrogluteal site, using the nurse s left hand on the patient s right hip. The nurse cleans a 2-inch circle and quickly inserts the needle at a 90-degree angle. The nurse injects the medication slowly, waits 10 seconds and removes the needle. Which of the following actions made by the nurse require correction? (Select all that apply.)
-The equipment obtained -Touching the needle shaft. -Method of administering the injection.
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.
0.4ml
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.
0.5ml
Match the angle of insertion to the type of injection. 1. Intradermal 2. IM 3. Subcutaneous
1. 5 to 15 degrees 2. 90 degrees 3. 45 to 90 degrees
Match the medication order to the dispensary label. 1. Morphine sulfate 5 mg subcutaneous every 4 hours 2. Morphine sulfate 8 mg and promethazine (Promethacon) 25 mg IM postoperatively 3. Digoxin (Lanoxin) 100 mcg intramuscular every day 4. Streptomycin sulfate 0.64 g IM every day
1. D 2. C 3. A 4. B
Read the medication information sheet linked to each medication name below. Match the medication to reactions that assistive personnel should report to the nurse. 1. Meperidine hydrochloride 50 mg and atropine 0.3 mg Meperidine hydrochloride atropine 2. Digoxin (Lanoxin)Digoxin (Lanoxin) 3. Morphine sulfateMorphine sulfate 4 Streptomycin sulfateStreptomycin sulfate
1. Difficulty breathing, muscle flaccidity, cyanosis, rash, extreme somnolence, tachycardia, palpitations, abdominal distention, nausea, vomiting, confusion 2. Pulse rate below 60, nausea, vomiting, halos or "yellow" vision 3. Respiratory depression, rash, severe nausea, vomiting, constipation 4. Unusual bleeding or bruising, flank pain, confusion, lack of urine output
Match the equipment necessary to deliver each type of injection. 1. Medication administration recordNeedle for withdrawingUnopened an alcohol swabDiluent1- to 3-mL syringeDisposable glovesMedication vial21- to 25-gauge needle1-1.5 inch needle 2. Medication administration recordFilter needle4 Small gauze pad and unopened an alcohol swab/Medication ampuleDisposable gloves1-mL syringe26- to 27-gauge needle3/8 inch needle 3. Medication administration recordUnopened an alcohol swab50- or 100-unit syringe25- to 27-gauge needleDisposable glovesMedication vial3/8 to 5/8 inch needle
1. Intramuscularly, requiring reconstitution 2. Intradermally from ampule 3. Subcutaneous insulin
Match the drug to the reaction that NAP should report.(You may click on the medication name for additional information.) 1. Xylocaine intradermally 2. Ampicillin intramuscularly 3. Novolin R and unit Novolin N subcutaneously
1. Pain or swelling at site 2. Difficulty breathing, rash, itching, unusual bleeding or bruising, abdominal cramps, severe watery diarrhea, or seizures 3. Hypoglycemic reaction (weakness, tremors, confusion, diaphoresis)
Match the injection location to the type of injection. 1. Anterior Thigh 2. Vastus Lateralis 3. Outer Posterior Arm 4. Ventralgluteal 5. Deltoid 6. Inner Forearm 7. Abdomen 8. Upper back
1. b 2. b 3. a 4. b 5. b 6. c 7. a 8. c
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.
1.5ml
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.
1.6ml
The nurse is preparing to give an injection for allergy testing; what would be the best needle gauge to use?
25 or 27
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
If the drug order specifies ampicillin sodium 500 mg IM every 6 hours, and this medication (see label) , ______ mL is the correct dose (enter number only).
2ml
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
At what angle should a subcutaneous injection be delivered in an obese adult?
90 degrees
The nurse has just given an intradermal injection; what does the nurse expect to see?
A raised, fluid-filled bleb resembling a mosquito bite
If the drug order specifies 10 units Novolin R and 20 units Novolin N subcutaneous every AM, and this medication (see label) What is the correct dose?
A. 30 units
What diluent is required for this medication? The insert states diluents 0.9% NaCl
A. Sodium chloride
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?
Administer the injection.
The nurse is administering a subcutaneous injection of enoxaprin (Lovenox). Which of the following actions would minimize pain and discomfort for the patient? (Select all that apply.)
Asking the patient to relax the site chosen for injection. Inserting the needle quickly.
Why should the nurse avoid massaging the intradermal injection site?
Because it will disperse the medication into the underlying tissues
The nurse is giving a tuberculosis test injection; at what angle does the nurse insert the needle?
Bevel up, 5- to 15-degree angle
Which of the following medications requires a diluent?
C. 500mg Ampicillin
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.
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.
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: (Select all that apply.)
Disposable gloves Needle for withdrawing 25- to 27-gauge needle 3/8 - 5/8" length needle 1-mL syringe
Which of the following is a correct sequence for the description of medication preparation (assume that an alcohol swab is being used when appropriate)?
Draw up air and inject it into the modified insulin vial, draw up air and inject it into the regular insulin vial, draw up regular insulin, and draw up modified insulin.
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: (Select all that apply.)
Filter needle Disposable gloves 21- to 25-gauge needle 1 - 1.5" length needle 1-mL syringe
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
Why is a filter needle used to withdraw medication from an ampule?
It prevents entry of glass into the syringe.
When withdrawing medication from a vial, why is it important to first inject air into the vial?
It prevents the buildup of negative pressure in the vial.
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: (Select all that apply.)
Needle for withdrawing 25- to 27-gauge needle Disposable gloves 5/8 inch needle 1-mL syringe
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: (Select all that apply.)
Needle for withdrawing 3-mL syringe Disposable gloves 21- to 25-gauge needle 1 - 1.5" length needle
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: (Select all that apply.)
Needle for withdrawing Diluent 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, 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: (Select all that apply.)
Needle for withdrawing Diluent 1- to 3-mL syringe Disposable gloves 21- to 25-gauge needle 1 to 1.5 inch needle
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.
Before giving the patient an injection from a vial, the nurse changes needles. This is done to: (Select all that apply.)
Provide a sharper needle for a less painful injection. Prevent medication from tracking through tissues.
The nurse is working with a NAP who she knows has helped care for her diabetic mother. The nurse is busy with the admission of a new patient. What can the nurse delegate to the NAP?
Reporting if the patient is exhibiting signs of hypoglycemia.
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: (Select all that apply.)
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.
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 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.
Generally with a subcutaneous injection, medication absorption is _____________than that of an IM injection
slower
