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The nurse is preparing to give an aqueous intramuscular (IM) injection to an average-sized adult. Which actions are appropriate? (Select all that apply.)
- A. Choose a 26- or 27-gauge, 1/4 to 1/2-inch needle.
- B. Choose a 20- to 25-gauge, 1- to 1 1/2-inch needle.
- C. Choose the dorsogluteal site, the preferred site for IM injections for adults.
- D. Insert the needle at a 45-degree angle.
- E. Insert the needle at a 90-degree angle.
- F. Before injecting the medication, withdraw the plunger to check for blood return.
Correct Answer: B,E,F
Rationale: For IM injections in adults, use a 20- to 25-gauge, 1- to 1 1/2-inch needle, insert at a 90-degree angle, and check for blood return to avoid intravascular injection. The dorsogluteal site is not preferred due to nerve risks; the ventrogluteal site is recommended. A 26- or 27-gauge needle is too small, and a 45-degree angle is for subcutaneous injections.
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When giving a buccal medication to a patient, which action by the nurse is appropriate?
- A. Encouraging the patient to swallow, if necessary
- B. Administering water after the medication has been given
- C. Placing the medication between the upper or lower molar teeth and the cheek
- D. Placing the tablet under the patient's tongue and allowing it to dissolve completely
Correct Answer: C
Rationale: Buccal medications are placed between the molar teeth and the cheek for absorption. Swallowing, giving water, or placing under the tongue (sublingual) are incorrect for buccal administration.
A patient is to receive hydromorphone 1.5 mg IV push now. The medication comes in a prefilled syringe, 2 mg/mL. Identify how many milliliters the nurse will administer for this dose.
Correct Answer: 0.75 mL
Rationale: To calculate: 2 mg/1 mL = 1.5 mg/x mL. Cross-multiply: (2 * x) = (1 * 1.5); 2x = 1.5; x = 1.5/2 = 0.75 mL.
A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion?
- A. 15 degrees
- B. 45 degrees
- C. 60 degrees
- D. 90 degrees
Correct Answer: D
Rationale: The proper angle for IM injections is 90 degrees to ensure the medication reaches the muscle layer. The other angles are incorrect for IM administration.
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.
The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection?
- A. Using the Z-track method
- B. Inserting the needle at a 5- to 15-degree angle until resistance is felt
- C. Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle
- D. Spreading the skin tightly over the injection site, inserting the needle, and then releasing the skin
Correct Answer: C
Rationale: For subcutaneous injections in obese patients, pinching the skin and inserting the needle at a 90-degree angle ensures delivery into the subcutaneous tissue. The Z-track method is for IM injections, a 5- to 15-degree angle is incorrect, and spreading the skin is not appropriate for subcutaneous administration.