A nurse is caring for a client who has ulcerative colitis and is receiving sulfasalazine. Which of the following findings requires immediate intervention?

A. Insert the needle at a 45° or 90° angle. Enoxaparin is administered subcutaneously, and subcutaneous injections should be given at either a 45° or 90° angle, depending on the client’s body size and the amount of subcutaneous tissue available. A 90° angle is typically used for clients with more subcutaneous tissue, while a 45° angle is appropriate for those with less.

B. Hold the skin taut during administration. When giving subcutaneous injections, the skin should be gently pinched rather than held taut. Pinching helps ensure the medication is delivered into the fatty tissue rather than the muscle, reducing the risk of intramuscular injection, which can increase bleeding risk with anticoagulants like enoxaparin.

C. Massage the injection site after administering the enoxaparin. Massaging the injection site is contraindicated because it can cause tissue irritation, bruising, and increased risk of bleeding. Instead, gentle pressure may be applied with a gauze pad if necessary to minimize bleeding.

D. Use a 4 cm (1.6 in) needle. A needle length of 4 cm (1.6 inches) is too long for a subcutaneous injection and increases the risk of intramuscular administration, which could lead to increased bleeding and bruising. The recommended needle length for subcutaneous injections is typically ½ inch (1.25 cm) to ⅝ inch (1.6 cm) to ensure proper medication delivery.

A. Varenicline. Varenicline is used to aid smoking cessation by reducing nicotine cravings and withdrawal symptoms. It does not have a role in managing acute alcohol withdrawal and would not be effective in preventing withdrawal-related complications.

B. Diazepam. Diazepam, a benzodiazepine, is commonly used to manage acute alcohol withdrawal by preventing seizures, reducing agitation, and alleviating autonomic hyperactivity (e.g., tachycardia, hypertension). It enhances GABA activity, which helps counteract the excitatory effects of alcohol withdrawal, reducing the risk of delirium tremens (DTs).

C. Clonidine. Clonidine is an alpha-2 agonist that helps control autonomic symptoms such as elevated blood pressure and heart rate. While it may be used as an adjunct therapy, it does not prevent seizures or delirium, making it insufficient as a primary treatment for alcohol withdrawal.

D. Methadone. Methadone is used for opioid withdrawal and maintenance therapy in opioid dependence. It does not alleviate alcohol withdrawal symptoms or prevent complications such as seizures or delirium, making it inappropriate for this condition.