A nurse is planning to administer ceftriaxone IM to an adult client. Which of the following actions should the nurse plan to take?

Administer the medication using a 5/8-inch needle.

Administer the medication using a Z-track technique.

Administer the medication in the deltoid muscle.

Administer the medication at a 45° angle.

Answer and Explanation

The Correct Answer is B

A) Administer the medication using a 5/8-inch needle:
Ceftriaxone is typically administered using a longer needle to ensure proper injection into the muscle. A 5/8-inch needle is more suitable for subcutaneous injections rather than intramuscular (IM) injections.

B) Administer the medication using a Z-track technique:
The Z-track technique is appropriate for IM injections of medications like ceftriaxone, which can be irritating to tissues. This technique helps prevent the medication from leaking into the subcutaneous tissue and minimizes discomfort by creating a zigzag path in the muscle.

C) Administer the medication in the deltoid muscle:
Ceftriaxone is generally administered in larger muscle groups, such as the vastus lateralis or gluteus muscle, rather than the deltoid. The deltoid is more commonly used for vaccines or smaller volume injections.

D) Administer the medication at a 45° angle:
For IM injections, the needle should be inserted at a 90° angle to the skin. A 45° angle is more appropriate for subcutaneous injections.

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Correct Answer is ["A","B","D","E"]

Explanation

A) Erythema:
Erythema, or redness of the skin at the IV insertion site, is a common sign of phlebitis. It indicates inflammation of the vein wall and is often one of the first observable symptoms.

B) Streak formation:
Streak formation along the path of the vein is a characteristic sign of phlebitis. It indicates that the inflammation is extending along the vein, which can be indicative of more severe irritation or infection.

C) Damp dressing:
A damp dressing may indicate leakage or poor adherence, but it is not a specific sign of phlebitis. Phlebitis is primarily associated with symptoms of redness, warmth, and tenderness, rather than the condition of the dressing.

D) Warmth at insertion site:
Warmth at the insertion site is another manifestation of phlebitis. It indicates increased blood flow to the area as a response to inflammation and irritation.

E) Throbbing:
Throbbing or pain at the insertion site is a common symptom of phlebitis. It results from inflammation of the vein and can be a sign of the condition's progression.

A. Discard the medication. B. Give the medication. C. Return the medication to the pharmacy. D. Notify the provider.

Correct Answer is A

Explanation

A) Discard the medication:
The safest action is to discard the medication. Medications past their expiration date may not be effective and could potentially be unsafe. Using expired medications can pose risks, and discarding them ensures that the client is not exposed to potentially compromised treatments.

B) Give the medication:
Administering expired medication is not appropriate as it could be ineffective or harmful. The expiration date indicates that the medication may no longer be guaranteed to work as intended or might have degraded, making it unsafe to give.

C) Return the medication to the pharmacy:
Returning expired medication to the pharmacy is not a standard practice. The medication should be disposed of according to facility protocols, and the pharmacy should be notified of the issue so they can take appropriate actions.

D) Notify the provider:
While notifying the provider is important if there are issues with medication availability or alternatives, the immediate action regarding the expired medication itself is to discard it. The provider can be informed as part of addressing the medication issue and determining the next steps.

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A nurse is planning to administer ceftriaxone IM to an adult client. Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has a peripheral IV with a continuous infusion. Which of the following findings is a manifestation of phlebitis? (Select all that apply.)

Correct Answer is ["A","B","D","E"]

Explanation

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Correct Answer is A

Explanation

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