A nurse is administering an intramuscular injection to a client using the Z-track method.
Which of the following actions should the nurse take?
Release the skin before withdrawing the needle.
Insert at a 45° angle.
Withdraw the needle quickly.
Pull the skin laterally.
The Correct Answer is D
A. With the Z-track method, the skin is pulled laterally or to the side before the needle is inserted and released after the injection is administered to ensure the medication remains within the muscle and does not leak into the subcutaneous tissue.
B. The angle of insertion for intramuscular injections can vary depending on factors such as the client's body habitus and the length of the needle but is typically 90 degrees.
C. The needle should be withdrawn slowly and steadily to minimize tissue trauma and prevent medication leakage.
D. The Z-track method involves pulling the skin laterally or to the side before inserting the needle to create a zigzag pathway for the medication. This helps seal the needle track after the injection, reducing the risk of medication leakage into subcutaneous tissues.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Using a straw can increase the risk of aspiration for clients with dysphagia; thickened liquids should be consumed from a cup.
B. Taking breaks during meals can aid in swallowing and reduce the risk of aspiration.
C. Elevating the head of the bed to 90° helps prevent aspiration during swallowing.
D. Tucking the chin can help close off the airway during swallowing, reducing the risk of aspiration.
Correct Answer is D
Explanation
A. While a prescription may be necessary, attempting less restrictive alternatives should be the first action.
B. Documentation is important but should not precede attempting less restrictive alternatives.
C. Education about the use of restraints is important but should follow attempts at less restrictive alternatives.
D. The nurse should exhaust all possible alternatives to restraints before considering their use, in line with the principle of least restrictive intervention.
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