A nurse is planning to administer an IM injection into a client's deltoid muscle. Which action should the nurse take?

Inject a volume of less than 2 mL.

Inject the medication at a 90 degree angle.

Inject the medication 12.7 cm (5 in) below the client's acromion process.

Use a 21-gauge needle for the injection.

Answer and Explanation

The Correct Answer is B

A) Inject a volume of less than 2 mL: While it is generally recommended to inject a volume of less than 2 mL into the deltoid muscle to avoid discomfort and ensure proper absorption, this is not the primary action to focus on when planning the injection.

B) Inject the medication at a 90 degree angle: This is the correct action. Administering an intramuscular (IM) injection at a 90-degree angle ensures that the medication is delivered deep into the muscle tissue, which is necessary for proper absorption and effectiveness.

C) Inject the medication 12.7 cm (5 in) below the client’s acromion process: The correct injection site for the deltoid muscle is typically 2-3 finger widths (approximately 2.5-5 cm) below the acromion process, not 12.7 cm. Injecting too far below the acromion process could result in an incorrect injection site.

D) Use a 21-gauge needle for the injection: While a 21-gauge needle can be used for IM injections, the gauge of the needle is not the primary focus in this context. The angle of injection is more critical to ensure proper delivery of the medication.

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Correct Answer is A

Explanation

A. The drug will be more effective when given in a nonenteral route:
Morphine has a high first-pass effect when taken orally, meaning that a significant amount of the drug is metabolized in the liver before it reaches systemic circulation. This reduces the amount of active drug available in the bloodstream. To avoid this extensive metabolism, morphine is often administered through nonenteral routes, such as intravenous or subcutaneous, where it bypasses the digestive system and liver first-pass metabolism, resulting in higher systemic bioavailability and effectiveness.

B. The drug will be most effective when given orally:
Due to the high first-pass effect of oral morphine, a significant portion of the drug is metabolized by the liver before it reaches systemic circulation. This means that oral morphine is often less effective compared to other routes of administration, such as intravenous, because the bioavailability of the drug is reduced.

C. The drug is excreted by the kidneys at a slower rate than most medications:
The high first-pass effect primarily affects the drug's absorption and systemic availability rather than its excretion rate. The rate at which a drug is excreted by the kidneys is generally unrelated to its first-pass effect. Morphine’s excretion is influenced by its metabolism and clearance, but not directly by the first-pass effect.

D. The kidney will metabolize some of the drug before it reaches the bloodstream:
The first-pass effect occurs primarily in the liver, not the kidneys. It involves the metabolism of the drug by the liver before it reaches systemic circulation. Therefore, this option incorrectly attributes the first-pass effect to kidney metabolism.

A. Increase the duration of action of the medication B. Decrease the frequency of subsequent doses. C. Achieve therapeutic drug levels more rapidly D. Minimize the risk of adverse effects

Correct Answer is C

Explanation

A. Increase the duration of action of the medication:
A loading dose is not intended to increase the duration of action of a medication. Instead, it aims to rapidly achieve therapeutic levels in the bloodstream. The duration of action is primarily influenced by the drug's half-life and how it's metabolized and excreted, rather than the initial dose.

B. Decrease the frequency of subsequent doses:
The primary goal of a loading dose is to reach therapeutic levels quickly, not necessarily to alter the frequency of future doses. While a loading dose can help achieve therapeutic levels faster, the dosing schedule is determined by the drug's pharmacokinetics and the condition being treated.

C. Achieve therapeutic drug levels more rapidly:
The main purpose of a loading dose is to quickly achieve a concentration of the medication in the blood that is sufficient to be therapeutic. By giving a larger initial dose, the medication reaches effective levels faster compared to gradually reaching those levels with smaller, incremental doses.

D. Minimize the risk of adverse effects:
Minimizing adverse effects is not the primary aim of a loading dose. While achieving therapeutic levels quickly may indirectly help in reducing symptoms and improving outcomes, the main purpose of a loading dose is to reach effective drug levels promptly, not specifically to reduce adverse effects.

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A nurse is planning to administer an IM injection into a client's deltoid muscle. Which action should the nurse take?

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