A client with hypertension currently takes two and a half tablets of bisoprolol per day, each containing 100 mg. The new order is 500 mg of bisoprolol per day.
What instruction should be given to this client for the effective management of hypertension?

These statements are correct because they follow the guidelines for intradermal injections, which are used for skin testing, such as for allergies or tuberculosis. Intradermal injections are given into the dermis, which is the layer of skin below the epidermis.
The needle is inserted with the bevel of the needle upward at a 10- to 15-degree angle to ensure that the medication is delivered into the dermis and not into the subcutaneous tissue or the epidermis. The bevel is

the slanted part of the needle tip that creates a sharp point. Inserting the needle with the bevel upward also reduces tissue trauma and bleeding.
The inner arm or upper back are the preferred sites for intradermal injections because they have thin skin and minimal hair, which makes it easier to see and measure any reactions. The inner arm is usually used for adults, while the upper back is used for children.
The other statements are not correct because they do not apply to intradermal injections or they contain false information.

a. A depressed area around the injection sites indicates a positive reaction. This statement is false because a depressed area, also known as induration, indicates a negative reaction. A positive reaction is indicated by a raised area, also known as a wheal, that is larger than a certain size depending on the type of test.

b. After the insertion of the needle, a healthcare provider should aspirate for a blood return. This statement does not apply to intradermal injections because aspiration is not necessary for this type of injection. Aspiration is the process of pulling back on the plunger of the syringe to check for blood in the needle before injecting the medication. This is done to avoid injecting into a blood vessel, which can cause adverse effects or reduce the effectiveness of the medication. However, intradermal injections are given into very superficial layers of skin where there are no blood vessels, so aspiration is not required.

This answer is correct because it is based on a series of unit conversions and calculations. The nurse should follow these steps to provide safe medication to the child:

1) Convert the child's weight from pounds to kilograms by dividing by 2.2, since there are 2.2 lbs in 1 kg. The child weighs 20 kg.

2) Multiply the prescribed dose per kilogram by the child's weight in kilograms to get the total dose in milligrams. The child needs 40 mg of pyrimethamine.

3) Use the ratio given on the drug label to convert the total dose in milligrams to the volume in milliliters. The nurse can set up a proportion as follows:

1 mg / 5 mL = 40 mg / x mL

Cross-multiplying and solving for x gives:

x = 200 mL

Therefore, the nurse should administer 200 mL of medication to deliver 40 mg of pyrimethamine to the child.

4) Convert the volume in milliliters to the volume in teaspoons by dividing by 5, since there are 5 mL in 1 tsp. The nurse should administer 40 tsp of medication to the child.

5) Convert the volume in teaspoons to the volume in cups by dividing by 48, since there are 48 tsp in 1 cup. The nurse should administer 0.83 cups of medication to the child.