Question 1

The nurse is preparing to administer an immunization to a toddler.Which action by the nurse is appropriate?

Accepted Answer

The vastus lateralis is the preferred injection site for administration of immunizations to infants, toddlers, and children.With young children, it helps to grasp the body of the muscle during injection to be sure the medication is deposited in muscle tissue.The muscle is located on the anterior lateral aspect of the thigh.In an adult, one hand is placed above the knee and one below the greater trochanter to locate the muscle.To relax the muscle, the patient lies flat with the knee slightly flexed and the foot externally rotated or assumes a sitting position.A side-lying position would not be appropriate for this immunization.

Question 2

The nurse is preparing to administer a medication using a volume-controlled administration set or Volutrol.Which action should the nurse do first?

Accepted Answer

The Volutrol is filled with the desired amount of IV fluid (50 to 100 mL) by opening the clamp between the Volutrol and the main IV bag.After the Volutrol is filled with the desired amount of fluid, the clamp is closed and the clamp on the air vent of the Volutrol is checked and opened if necessary.The injection port on the Volutrol is cleaned, and the medication is injected through the port.

Question 3

The nurse is preparing an injection of 0.45 mL of medication for a pediatric patient.Which syringe is most appropriate?

Accepted Answer

The tuberculin syringe is calibrated in hundredths of a milliliter and has a capacity of 1 mL.It is used to prepare small amounts of medication such as small, precise doses for infants or young children.It is also used for intradermal and subcutaneous injections.An insulin syringe is used to administer insulin and is calibrated in units.A 3-mL syringe and a 10-mL syringe are calibrated in 0.2 of a milliliter and are not accurate for small volumes.

Question 4

The nurse is preparing several medications that are administered parenterally.The patient receiving which medication will have an intradermal injection?

Accepted Answer

The nurse typically gives intradermal injections for skin testing, for example, in tuberculin screening and allergy tests.Opioid pain medications, low-molecular-weight heparin, and insulin are administered subcutaneously, not intradermally.

Question 5

The nurse is preparing to administer an intramuscular (IM) injection to a 6-month-old infant.Which injection site is the most appropriate for this patient?

Accepted Answer

On the basis of the evidence, the vastus lateralis is the recommended site for pediatric IM injections for infants up to 12 months of age.The deltoid is the recommended site for children 18 months of age and older.The dorsogluteal site should not be used as an IM injection site.The abdomen is used for subcutaneous injection, not for IM injection.

Question 6

The nurse is preparing an intramuscular injection for a thin elderly patient.The nurse is aware that the maximum volume most likely tolerated by this patient is which amount?

Accepted Answer

Elderly adults and thin patients often tolerate only 2 mL in a single injection.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.

Question 7

The nurse administers a tuberculin screening test to a patient who has no known risk factors for tuberculosis.When the test site is read 48 hours later, which result is considered positive?

Accepted Answer

A raised, reddened, or hard zone around the test site indicates a positive tuberculin skin test.An induration of 15 mm or more indicates a positive reaction in patients with no known risk factors for TB.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 are immunosuppressed.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.

Question 8

After insertion of the needle into the patient's ventrogluteal muscle, the nurse aspirates and notices a very small amount of blood in the syringe.What action should the nurse take?

Accepted Answer

Aspiration of blood into the syringe indicates possible placement into a vein.If blood appears in the syringe, remove the needle, dispose of the medication and syringe properly, and prepare another dose of medication for injection.

Question 9

A patient has orders for 10 units of glargine (Lantus) insulin and 5 units of regular insulin to be given at the same time.Which action by the nurse is appropriate?

Accepted Answer

If long-acting insulin glargine (Lantus) is ordered, it should not be mixed with other insulin preparations, so two separate injections are prepared.Air is injected into one vial, and this is followed by withdrawal of the medication.It doesn't matter which one is drawn up first because they are in separate syringes.

Question 10

The nurse is teaching a patient how to inject low-molecular-weight heparin.What instruction should be included in the teaching plan?

Accepted Answer

Gentle pressure for 30 to 60 seconds prevents bleeding at the site.To minimize the pain and bruising associated with low-molecular-weight heparin (LMWH), 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." LMWH comes in a prefilled syringe, and the air bubble should not be expelled before administration.Aspiration after a subcutaneous injection is not necessary.Aspiration after an LMWH injection is not recommended.

Question 11

The nurse is preparing to administer an intradermal injection to an adult patient.Which action should be taken by the nurse?

Accepted Answer

The angle of insertion for an intradermal injection is 5 to 15 degrees.If possible, the site should be 3 to 4 finger widths below the antecubital space and one hand width above the wrist.To administer an injection intradermally, use a tuberculin or small syringe with a short (3/8 to 5/8 inch), fine-gauge (25 to 27) needle.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.

Question 12

The nurse is preparing to administer an intramuscular injection via the Z-track method.Which action should be taken by the nurse?

Accepted Answer

For an intramuscular injection, the needle is inserted perpendicular to the patient's body as close to 90 degrees as possible.In using the Z-track method, the overlying skin and subcutaneous tissues are pulled approximately 2.5 to 3.5 cm (1 to 11ea595c_2bc5_5f69_af5c_df7a901f0955_TB5334_11 inches) laterally to the side with the ulnar side of the nondominant hand.Keep the needle inserted for 10 seconds after injection to allow the medication to disperse evenly.Release the skin after withdrawing the needle.

Question 13

A student nurse is preparing to administer an intramuscular injection into the ventrogluteal muscle.The nursing instructor should question which action by the student?

Accepted Answer

The patient should lie in either the supine or the lateral position while the ventrogluteal muscle is located.To locate the ventrogluteal site, the heel of the hand is placed over the greater trochanter of the patient's hip with the wrist almost perpendicular to the femur.The right hand is used for the left hip, and the left hand is used for the right hip.To relax the muscle, the patient lies on the side or back with the knee and hip flexed.

Question 14

The nurse is preparing to give a medication by IV bolus.When assessing the patient's IV insertion site, the nurse notes that it is warm, reddened, and tender.What action should the nurse take first?

Accepted Answer

Swelling, warmth, redness, and tenderness indicate infiltration or phlebitis.Stop the IV infusion, remove the IV catheter, treat the IV site as indicated by institutional policy, and insert a new IV catheter if therapy continues.

Question 15

The nurse is teaching a patient how to mix 5 units of regular insulin and 15 units of NPH insulin in the same syringe.The nurse determines that further instruction is needed if the patient does which of the following?

Accepted Answer

When rapid- or short-acting insulin is mixed with intermediate- or long-acting insulin, air should be injected into the intermediate- or long-acting insulin vial first without withdrawal of the medication.Regular insulin is withdrawn first, and then the combined total insulin dose is calculated before the NPH insulin is withdrawn from the vial.

Question 16

A patient with a continuous IV infusion has an order for ciprofloxacin to be given IV piggyback.Which action by the nurse is appropriate for administering the medication?

Accepted Answer

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.The piggyback is 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 tubing is occluded to check for blood return or to give an IV bolus, but not for a piggyback medication.

Question 17

The nurse is teaching a family member of an obese patient how to administer a subcutaneous U-100 insulin injection to the patient.Which instruction should be included in the teaching plan?

Accepted Answer

For an obese patient, the skin is pinched and the needle is inserted quickly and firmly at a 90-degree angle.Massage can damage underlying tissue.Subcutaneous U-100 insulin is given using an insulin syringe with a preattached needle of 28 to 31 gauge.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-a practice that maintains consistent insulin absorption from day to day.

Question 18

The nurse is administering a parenteral medication to the patient.Which action by the nurse demonstrates proper technique?

Accepted Answer

Strict aseptic technique is used during all steps of preparation and administration of parenteral medications.Work-arounds bypass a procedure, policy, or protocol and should not be used.Medication should be injected slowly and smoothly.The needle should be inserted smoothly and quickly.

Question 19

The nurse is preparing to administer an intravenous (IV) antibiotic using a mini-infusion pump.Which action should the nurse do first?

Accepted Answer

After connecting the prefilled syringe to the mini-tubing, the nurse carefully applies pressure to the syringe plunger to fill the tubing with fluid and to ensure that the tubing is free of air bubbles to prevent air embolus.After the tubing is filled with fluid, the syringe is placed into the mini-infusion pump and is hung on an IV pole.Then the mini-infusion tubing is connected to the main IV line.

Question 20

The nurse is preparing a medication that comes in an ampule.Which action by the nurse is appropriate?

Accepted Answer

Filter needles filter out any fragments of glass, and reaching the bottom of the ampule allows the medication to be completely withdrawn.The top of the ampule is tapped to move the fluid from the neck into the bottom of the ampule, where it is withdrawn.The ampule is held upside down or is set on a flat surface for withdrawal of the medication.The medication will not spill from the ampule after opening unless the needle tip or shaft touches the rim.The rim is considered contaminated and should not be touched by the needle.

Quiz 22: Parenteral Medications