Nokea
The nurse is giving an intradermal (ID) injection and will choose which syringe for this injection?
- A. interderm_1.PNG
- B. interderm_2.PNG
- C. interderm_3.PNG
- D. interderm_4.PNG
Correct Answer: B
Rationale: The proper size syringe for ID injection is a 1-mL tuberculin. The other syringes pictured are incorrect. Insulin syringes (marked in units) are not used for intradermal injections.
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After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. Which of these is the best action for the nurse to take at this time?
- A. Apply heat.
- B. Massage the area.
- C. Do nothing.
- D. Report the bleb to the physician.
Correct Answer: C
Rationale: A small bleb is an expected outcome after an intradermal injection for skin testing, indicating proper administration. No further action is needed.
The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation?
- A. The medication is known to be irritating to tissues.
- B. The patient is emaciated and has very little muscle mass.
- C. The medication must be absorbed quickly into the tissues.
- D. The patient is obese and has a deep fat layer below the muscle mass.
Correct Answer: A
Rationale: The Z-track method is used for medications that irritate tissues or cause staining, preventing leakage into subcutaneous tissues. It is not specifically for emaciated or obese patients or for rapid absorption.
When giving parenteral medications, the nurse will use Standard Precautions, which include what action?
- A. Bending the needle to prevent reuse
- B. Recapping needles to prevent needle sticks
- C. Discarding all syringes and needles in the trash can
- D. Discarding all syringes and needles in a puncture-resistant container
Correct Answer: D
Rationale: Standard Precautions require discarding syringes and needles in a puncture-resistant container to prevent needle-stick injuries. Bending or recapping needles and using a trash can are unsafe.
The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next?
- A. Flushing the lock
- B. Regulating the IV flow
- C. Clamping the tubing for 10 minutes
- D. Holding the patient's arm up to improve blood flow
Correct Answer: A
Rationale: Flushing the IV lock with saline or heparin (per facility policy) after administering an IV push medication ensures the medication is cleared from the lock and prevents clotting. The other actions are not appropriate.
When administering nasal spray, which instruction by the nurse is appropriate?
- A. You will need to blow your nose before I give this medication.'
- B. You will need to blow your nose after I give this medication.'
- C. When I give this medication, you will need to hold your breath.'
- D. You need to sit up for 5 minutes after you receive the nasal spray.'
Correct Answer: A
Rationale: Clearing the nasal passages by blowing the nose before administering nasal spray ensures effective delivery. Blowing afterward removes the medication, holding breath is unnecessary, and the patient should remain supine, not sit up.