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Showing 15 questions, Sign in for moreThe nurse preparing an IM injection to be administered will provide accurate and safe medication practices by following which principles? Select all that apply.
The nurse is preparing to give an injection into the client’s abdomen for the early morning insulin dose. Which needle length and gauge is most appropriate to use?
The nurse is discussing with an orientee the advantages of the prefilled cartridge-needle units and syringes. Which statements by the nurse are accurate? Select all that apply
The nurse needs to determine the difference between an ampule, a vial, and a Mix-O-Vial. Indicate with an arrow the technique used for the different parenteral dose forms.
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DOSAGE FORMS |
TECHNIQUES USED |
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Ampules |
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Vials |
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Mix-O-Vials |
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Explanation
Parenteral medications come in different dosage forms—ampules, vials, and Mix-O-Vials—each requiring specific techniques to ensure safe and accurate medication withdrawal. Nurses must be able to distinguish between these forms and apply the correct handling method.
Rationale for correct answer:
Ampules are sealed glass containers that must be broken open to access the medication. Breaking the ampule can release microscopic glass shards. To prevent these particles from entering the syringe and being injected into the patient, nurses must use a filter needle or filter straw when withdrawing the medication.
Vials are closed systems sealed with a rubber stopper. When medication is withdrawn, the pressure inside the vial decreases. Injecting an equal volume of air before withdrawal equalizes pressure, preventing a vacuum from forming and allowing the medication to be drawn easily into the syringe.
Mix-O-Vials are dual-chambered containers that keep a powder and diluent separate until administration. To activate the Mix-O-Vial, the nurse must press down firmly on the top diaphragm, which breaks the seal between the chambers. This allows the diluent to mix with the powder, forming a solution that can then be withdrawn and administered.
Take-home points:
- Ampules require filter devices to prevent glass contamination.
- Air must be injected into vials to maintain pressure balance during withdrawal.
- Mix-O-Vials need activation by pushing the diaphragm to mix contents before use.
The nurse is teaching the client how to prepare 10 units of regular insulin and 5 units of NPH insulin for injection. List in the correct order the proper sequence for preparation that the nurse will describe to the client.
Explanation
When preparing a mixed dose of regular (short-acting) and NPH (intermediate-acting) insulin in one syringe, the nurse must follow a strict sequence to preserve medication integrity, avoid cross-contamination, and ensure safe administration. Proper technique minimizes dosage errors and supports stable blood glucose control.
Rationale for correct answer:
Wipe the tops of the insulin vials with alcohol
Cleaning the vial tops with an alcohol swab helps prevent introducing contaminants into the insulin solution when the needle is inserted. This is a key infection control step.
Inject appropriate volumes of air into the NPH vial and the regular insulin vial
Air is injected into each vial equal to the dose to be withdrawn. This maintains pressure balance and makes insulin withdrawal easier. Air should be injected into NPH first (cloudy), then regular (clear), but insulin should always be drawn from the regular vial first to prevent contaminating the clear insulin.
Withdraw 10 units of regular insulin into the syringe
Regular insulin (clear and short-acting) must be drawn first to avoid contamination with intermediate-acting NPH insulin, which is cloudy and contains a protein that alters absorption.
Withdraw 5 units of NPH insulin into the syringe to mix with the regular insulin
After the regular insulin has been drawn, the syringe is inserted into the NPH vial to withdraw the remaining dose. Drawing in this order avoids mixing the NPH with regular insulin inside the vials.
Mix the two insulins in the syringe by rolling between the palms and gently inverting the syringe several times
Gentle mixing helps ensure the NPH insulin, which tends to settle, is evenly distributed in the syringe. Vigorous shaking should be avoided as it can denature the insulin.
Inject the insulin in the proper subcutaneous site
The final step is administering the insulin subcutaneously, usually in the abdomen, thigh, or back of the arm. Site rotation helps prevent lipodystrophy and ensures consistent absorption.
Take-home points:
- Always draw clear (regular) insulin before cloudy (NPH) to prevent contamination.
- Inject air into both vials first, starting with NPH, then withdraw regular insulin.
- Roll insulin mixtures gently; never shake to preserve insulin integrity.
The nurse needs to determine which medications need to be in a tuberculin syringe and which need to be in a larger volume syringe. Indicate with an X which syringe would work.
Explanation
A tuberculin syringe is a small-volume syringe designed for the precise administration of low-dose medications, most commonly used for intradermal injections such as the Mantoux tuberculin skin test. It typically holds up to 1 mL of fluid and is calibrated in tenths and hundredths of a milliliter, allowing for accurate dosing of medications like vaccines, allergy tests, or pediatric medications.
Rationale for correct answer:
Subcutaneous injection (1.5 mL): A volume above 1 mL exceeds the capacity of a tuberculin syringe and should be given with a 3 mL syringe for safe administration.
Subcutaneous injection (0.5 mL): A tuberculin syringe (1 mL capacity) is ideal for small subcutaneous doses due to its fine calibration, allowing precise measurement.
Intradermal Mantoux test (0.1 mL): Requires a tuberculin syringe to ensure high precision for small-volume, shallow intradermal injections such as TB testing.
IM injection for nausea (2 mL): A larger syringe (e.g., 3–5 mL) is necessary for intramuscular delivery of this volume, which exceeds the tuberculin syringe capacity.
Take-home points:
- Use tuberculin syringes for volumes ≤1 mL, especially for intradermal or small subcutaneous doses.
- Larger volume syringes (≥3 mL) are required for IM injections or any dose over 1 mL.
- Always match syringe size to medication volume and route to ensure safe and accurate administration.
The nurse needs to mix two medications in the same syringe so that the client will only have to get one shot. List in order the steps necessary to mix two medications in one syringe.
Explanation
When a nurse needs to combine two compatible medications in a single syringe, it's essential to follow a structured process to maintain medication safety, dose accuracy, and sterility. This reduces the number of injections the patient receives and prevents complications from drug incompatibility or contamination.
Rationale for correct answer:
Check the compatibility of the two drugs:
Ensuring the medications are chemically and physically compatible avoids adverse reactions or drug inactivation.
Wipe off the tops of both vials:
Alcohol swabbing maintains aseptic technique before needle access to each vial.
Inject air into each vial equal to the volume to be withdrawn:
This prevents vacuum formation and makes it easier to withdraw the correct dose.
Withdraw the medication from the first vial:
Always draw from the first vial (usually the shorter-acting medication) before the second, to avoid contaminating the first vial.
Withdraw the medication from the second vial:
Insert the same needle into the second vial and carefully add the second medication to the same syringe without expelling air.
Mix the two medicines in the syringe by rolling between the palms and gently inverting:
Ensures that both medications are evenly distributed without creating air bubbles or froth.
Take-home points:
- Always check compatibility before combining two medications in one syringe
- Use aseptic technique consistently to prevent contamination.
- Follow a precise sequence to ensure safe mixing and accurate dosing.
The instructor asks the student nurse to gather the equipment needed to perform an intradermal injection. Which items are appropriate? Select all that apply.
A student nurse has been practicing subcutaneous injections in the laboratory and is about to administer her first insulin injection. List in correct order the proper sequence to follow when administering a subcutaneous injection.
Explanation
Administering subcutaneous insulin safely and effectively requires preparation, precision, and adherence to safety protocols. It is critical to follow a logical, evidence-based sequence that ensures proper medication delivery, maintains asepsis, and supports patient-centered care.
Rationale for correct answer:
Identify the client using two identifiers: Ensures patient safety and aligns with national safety standards to prevent medication errors.
Explain procedure to client: Promotes informed consent, reduces anxiety, and encourages cooperation during the procedure.
Prepare the insulin per prescriber’s orders: Confirms the correct dose and type of insulin is drawn and ready for administration.
Locate the appropriate site for administration: Choosing a site with sufficient subcutaneous tissue helps ensure proper absorption and reduces complications.
Cleanse the site with alcohol: Reduces microbial load at the injection site and minimizes infection risk.
Dart the needle in at a 45- to 90-degree angle: The angle is based on needle length and patient's body fat; ensures proper placement in subcutaneous tissue.
Inject the insulin: Delivering the medication as ordered after confirming proper site and technique.
Withdraw the needle: Done smoothly to avoid tissue trauma; apply gentle pressure if needed.
Document the administration: Ensures legal and clinical accountability and supports continuity of care.
Take-home points:
- Always confirm patient identity before any medication administration.
- Use correct injection angle (45–90 degrees) based on needle length and subcutaneous fat.
- Document immediately after administration to maintain accurate records and communicate care.
Why will a nurse who administers an IM medication of iron use the Z-track method of administration?
The nurse is finding the landmark of the acromion process and measuring down two to three fingerbreadths to administer an IM injection into which site?
A student nurse reads an order to give a 69-year-old client an IM injection. Which muscles could be used for injection sites for an adult? Select all that apply.
The nurse needs to administer an IM injection and chooses the rectus femoris muscle. What landmarks will the nurse use for the injection?
The nurse is preparing to administer an IM injection to an elderly client; what considerations need to be practiced? Select all that apply.
A nurse is starting a peripheral IV line for the first time in an extremity of an elderly client and knows which site is the best location for an IV line?
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