The nurse is precepting a new graduate nurse (GN) who is administering a prefilled enoxaparin injection to an obese client. Which action by the GN indicates the need for further education from the nurse preceptor?

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11ecbb05_cb3c_9af8_b433_71736f7c7c05_MD0009_00 Low-molecular-weight heparins (LMWHs) (eg, enoxaparin, dalteparin) are anticoagulants commonly used for prevention and treatment of deep venous thrombosis and pulmonary embolism. LMWH is administered subcutaneously and is often available in a prefilled syringe, which contains an air bubble to ensure delivery of the entire dose. During injection, the air bubble follows the medication out of the syringe, ensuring that no medication is left behind. The nurse should not expel the air bubble prior to administration as this could result in an incomplete dose and medication error (Option B). (Option A) After subcutaneous anticoagulant injection, the client should not rub the injection site as this increases bruising and the risk for hematoma. (Option C) A 90-degree angle is appropriate for a subcutaneous injection in an obese client. In general, subcutaneous injections are administered at a 90-degree angle if 2 in (5 cm) of tissue can be grasped or a 45-degree angle if only 1 in (2.5 cm) of tissue can be grasped. (Option D) Subcutaneous anticoagulants are best absorbed when administered in the lower part of the right or left lateral abdominal wall (ie, "love handles"), at least 2 in (5 cm) away from the umbilicus. Educational objective: Low-molecular-weight heparin is often available in a prefilled syringe, which contains an air bubble to ensure delivery of the entire dose during injection. The nurse should not expel the air bubble prior to administration as this could result in some medication being left in the syringe and an incomplete dose delivery.

The Nurse Is Precepting a New Graduate Nurse (GN) Who