A nurse is preparing to administer an IM injection to a client who has gonorrhea.
Which of the following actions should the nurse take?
Inject the medication at least 5 cm (2 in) from the umbilicus.
Use the Z-track technique to administer the medication.
Give the medication without aspirating prior to injection.
Administer the medication with a 27-gauge '/,-inch needle.
The Correct Answer is B
Choice A rationale:
Injecting the medication at least 5 cm (2 in) from the umbilicus is not a standard guideline for IM injections. The site of injection depends on factors such as the volume of medication and patient’s age and muscle mass.
Choice B rationale:
Using the Z-track technique to administer the medication is correct. This technique helps to seal the medication in muscle tissue, reducing leakage into subcutaneous tissue.
Choice C rationale:
Giving the medication without aspirating prior to injection is not recommended. Aspiration ensures that the needle is not in a blood vessel before injecting.
Choice D rationale:
Administering the medication with a 27-gauge '/,-inch needle may not be appropriate for an IM injection, especially for adults. A longer and larger gauge needle is typically used for IM injections.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Sublingual nitroglycerin should be taken without water. The tablet should be placed under the tongue and allowed to dissolve.
Choice B rationale:
It is recommended to take sublingual nitroglycerin before activities that might cause angina.
Choice C rationale:
The maximum recommended dosage is three tablets within 15 minutes, not four.
Choice D rationale:
Sublingual nitroglycerin should not be chewed. It should be allowed to dissolve under the tongue.
Correct Answer is B
Explanation
Choice A rationale:
Docusate sodium is a stool softener and does not have a direct effect on blood pressure. It is generally safe for individuals with hypertension.
Choice B rationale:
Pseudoephedrine is a decongestant that can raise blood pressure or interfere with the effectiveness of some prescribed blood pressure medications. Therefore, it is contraindicated for clients with hypertension.
Choice C rationale:
Omeprazole is a proton pump inhibitor used to decrease stomach acid. It does not have a significant impact on blood pressure and is generally safe for individuals with hypertension.
Choice D rationale:
Guaifenesin is an expectorant used to thin mucus in the air passages. It does not have a significant impact on blood pressure and is generally safe for individuals with hypertension.
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