A client is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. What is the correct angle that the nurse should use for the needle insertion?

A) 90 degrees: For intramuscular (IM) injections, including in the ventrogluteal site, the needle should be inserted at a 90-degree angle to ensure that the medication is deposited deep into the muscle tissue. This angle allows the needle to penetrate the skin and subcutaneous tissue directly into the muscle where it can be absorbed efficiently. The ventrogluteal site, being a large and well-muscled area, is ideal for IM injections because it is less likely to cause damage to nerves or blood vessels, and a 90-degree angle ensures proper placement of the medication.

B) 45 degrees: A 45-degree angle is commonly used for subcutaneous injections which go into the fatty tissue just beneath the skin. This angle ensures that the medication is delivered into the correct layer of tissue, allowing for slow absorption. However, when administering an IM injection, a 45-degree angle would not be deep enough to reach the muscle and could result in improper placement, potentially affecting the medication's effectiveness and increasing the risk of irritation at the injection site.

C) 15 degrees: A 15-degree angle is far too shallow for an intramuscular injection and is typically used for intradermal injections, where the medication is injected just beneath the skin into the dermal layer. Using such a shallow angle for an IM injection would likely cause the needle to remain in the subcutaneous tissue, preventing the medication from reaching the muscle layer and significantly reducing its effectiveness.

D) 60 degrees: A 60-degree angle is too steep for intramuscular injections. At this angle, the needle may not effectively reach the muscle tissue and could cause the medication to be injected too superficially into the subcutaneous layer. This would not allow for proper absorption of the drug and may lead to irritation or a delayed therapeutic effect.

A. Sodium: Sodium levels are important to monitor, but in the context of pantoprazole use, abnormal sodium levels are less commonly a direct concern. Pantoprazole primarily impacts the gastric environment rather than fluid or electrolyte balance in a way that would dramatically alter sodium levels.

B. Gastric pH: Pantoprazole works to increase gastric pH by reducing acid secretion, which is its primary therapeutic effect. A higher gastric pH is expected and beneficial in conditions like GERD or peptic ulcers.

C. Calcium: Pantoprazole, when used for extended periods, can interfere with calcium absorption, potentially leading to bone health issues like osteoporosis. However, changes in calcium levels typically do not pose an immediate or life-threatening concern unless significantly low or related to prolonged therapy. It is still something to monitor, but magnesium is a higher priority in this case.

D. Magnesium: Pantoprazole and other proton pump inhibitors (PPIs) are known to cause hypomagnesemia, especially with prolonged use. Low magnesium levels can lead to serious complications, including muscle spasms, seizures, and arrhythmias. Hypomagnesemia is a well-documented side effect of long-term PPI use, making it the most critical lab result to address.