Chapter 23: Administration of Parenteral Medications

Chapter 23: Administration of Parenteral Medications

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is teaching a patient to self-administer subcutaneous heparin at home. What does the nurse include in patient teaching?

a.	Use a 22-gauge, 1-inch needle for the heparin injections.
b.	Change needles after withdrawing the heparin from the vial.
c.	Instruct the patient and family to recap all needles used at home.
d.	Pinch a large area of skin and inject heparin into the center of the skin fold.

 

 

ANS:  D

The nurse instructs the patient to grab a large pinch of skin and inject the heparin into the center of the skin fold at a 90-degree angle to deposit the medication into subcutaneous tissue. A 22-gauge needle is too large for a subcutaneous injection; a 25- or 27-gauge needle is a better choice because a finer needle creates a smaller hole. As a result, the medication tends to remain in the subcutaneous space, the patient is more comfortable, and the skin develops scar tissue more slowly. Changing needles is not necessary. Needles are never recapped; the patient at home should obtain a sharps container or use an impenetrable container to hold used needles. The patient should label the container to prevent injury to others.

 

DIF:    Cognitive Level: Comprehend          REF:   Page 610-611| Page 613

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation

 

2. The nurse prepares to administer 2.2 mL of an oil-based medication intramuscularly to a male patient who is 5 feet 10 inches tall and weighs 165 pounds. Which needle and syringe combination should the nurse choose to administer the injection?

a.	20-gauge, 1 1/2-inch needle on a 3-mL syringe
b.	21-gauge, 1 1/2-inch needle on a 5-mL syringe
c.	23-gauge, 1-inch needle on a 3-mL syringe
d.	25-gauge, 1-inch needle on a 5-mL syringe

 

 

ANS:  A

The patient is well proportioned; because the medication is a thick solution requiring a deep intramuscular (IM) injection, the nurse chooses a slightly larger gauge needle, 20-gauge, which is 1 1/2 inches long, to accommodate the thick medication and to reach deep within the muscle. A 21-gauge needle is appropriate, but the syringe is too large. A 23-gauge needle is too small, and the oil would not be able to get through the lumen. A 25-gauge, 1-inch needle is far too narrow and short for an IM injection.

 

DIF:    Cognitive Level: Apply                   REF:   Page 614-615

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

3. A patient is admitted to the emergency department after a motor vehicle accident. The nurse sustains an accidental needlestick injury while performing a venipuncture on the patient. What is the nurse’s priority?

a.	Determine whether the needle was sterile.
b.	Follow agency policy for employee injuries.
c.	Inform the provider to screen the patient for antibodies.
d.	Obtain patient history of communicable diseases.

 

 

ANS:  B

The nurse’s priority after a needlestick injury is obtaining immediate treatment as outlined in agency policy. He or she needs baseline testing and, depending on the patient’s history and test results, administration of preventive treatments. The needle cannot be sterile after a venipuncture. The nurse’s priority is his or her own safety and receiving prompt treatment; informing the provider and gathering subjective data are secondary in importance.

 

DIF:    Cognitive Level: Apply                   REF:   Page 599, Box 23-1

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Assessment

 

4. When administering an intramuscular (IM) injection, the nurse obtains blood during aspiration. What action by the nurse is appropriate?

a.	Wait 30 minutes before giving the ordered medication.
b.	Notify the healthcare provider of the situation.
c.	Continue to administer the ordered medication.
d.	Stop the administration and discard the syringe.

 

 

ANS:  D

The injection is stopped, the needle is withdrawn, and the filled syringe is discarded. A new dose of medication is prepared in a new syringe with a new needle for the patient. Waiting 30 minutes is not necessary because the medication is due and can be given as soon as a new syringe is prepared. Notifying the healthcare provider is unnecessary. Continuing with the injection is dangerous because the medication could be given intravenously instead of intramuscularly.

 

DIF:    Cognitive Level: Comprehend          REF:   Page 619

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

5. The nurse is teaching a patient to self-administer insulin. The patient is 5 feet tall and weighs 197 pounds. Which of the following does the nurse include in patient teaching?

a.	Insert the needle into abdominal tissue at a 90-degree angle.
b.	Include an air space when drawing up the prescribed dose.
c.	Aspirate before injecting to ensure that the needle is not in a vessel.
d.	Instruct the patient to use an insulin syringe with a 1-inch needle.

 

 

ANS:  A

The nurse instructs the patient to insert the needle at a 90-degree angle to inject insulin into subcutaneous tissue because the patient is obese and likely to have excessive abdominal adipose tissue. The 5/8-inch needle is long enough to reach subcutaneous tissue for proper administration of insulin but not long enough to reach muscle. The nurse instructs the patient to remove all air bubbles from the syringe before administering the insulin. Aspiration is unnecessary for subcutaneous injections because the tissue is avascular. A 1-inch needle is unnecessary because a 5/8-inch needle reaches the same subcutaneous tissue in this patient as a 1-inch needle.

 

DIF:    Cognitive Level: Apply                   REF:   Page 609-610

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation