The nurse is administering an intradermal (ID) injection to a client. Which action should the nurse take?

Massage the site gently after injection.

Ensure bevel of the needle is pointing up.

Hold the syringe perpendicular to the skin.

Select upper arm as the injection site.

Answer and Explanation

The Correct Answer is B

B. The needle should be inserted with the bevel facing up (visible through the skin). The goal is to deposit the medication into the epidermal layer (not subcutaneous tissue).

A. Massaging the site after injection can cause the medication to spread beyond the intended area, leading to inaccurate results or potential complications.

C. The correct angle for an intradermal injection is 5 to 15-degree angle. This angle allows for proper placement of the medication just below the epidermis.

D. Intradermal injections are usually administered on the forearm or the upper back, where the skin is thin and easily lifted to create a wheal.

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Correct Answer is B

Explanation

B. Smoking is a significant risk factor for the development of cardiovascular disease, as it contributes to the narrowing and hardening of the arteries, increases blood pressure, reduces oxygen supply to tissues, and promotes the formation of blood clots.

A. Chronic stress can contribute to cardiovascular disease by raising blood pressure, increasing heart rate, and promoting inflammation.

C. Regular physical activity is crucial for cardiovascular health. It helps strengthen the heart muscle, lower blood pressure, improve cholesterol levels, control weight, and reduce stress.

D. A low-fat diet, particularly one that is high in fruits, vegetables, whole grains, and lean proteins, can help lower cholesterol levels, reduce blood pressure, and manage weight, all of which are important for heart health.

Although A, C, D play a role in preventing cardiovascular disease, smoking is the major risk factor for cardiovascular disease.

A. Remind the client no milk or creamer can be added to the coffee. B. Determine which member of the nursing staff brought the cup of coffee to the client. C. Remove the coffee from the tray, advising the client that it is not included in the diet. D. Consult with the dietitian to learn if the client is allowed to drink coffee.

Correct Answer is C

Explanation

C. A clear liquid diet typically includes transparent or translucent liquids that are easy to digest and leave minimal residue in the gastrointestinal tract. Coffee, especially if it contains milk or creamer, is not considered a clear liquid and is not usually permitted on a clear liquid diet.

A. Reminding the client no milk or creamer can be added to the coffee may be appropriate for clients on other dietary restrictions but does not address the issue of coffee not being part of a clear liquid diet.

B. Determining which member of the nursing staff brought the cup of coffee to the client is not necessary unless there is a need to investigate a specific incident or identify potential lapses in care.

D. Consulting with the dietitian to learn if the client is allowed to drink coffee may be appropriate for clarifying dietary restrictions or allowances, but in the context of a clear liquid diet, coffee is typically not permitted regardless of the dietitian's input.

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The nurse is administering an intradermal (ID) injection to a client. Which action should the nurse take?

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Naxlex Comprehensive Predictor Exams

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