Basic Pharmacology For Nurses 15th Edition By Clayton – Test Bank

Chapter 11: Parenteral Administration: Intradermal, Subcutaneous, and Intra-muscular Routes

Test Bank

MULTIPLE CHOICE

1. The nurse is educating a patient about diabetes. Based on recommendations from the American Diabetes Association, which statement by the nurse is best regarding site rotation?
A. “Insulin injection sites should always be in the abdomen to ensure absorption into the stomach.”
B. “It is important to rotate injection sites systematically within one area before progressing to a new site for injection.”
C. “Following exercise, site rotation is not indicated because the circulation in the muscles will absorb the medication efficiently.”
D. “If you aspirate, site rotation can be done every other day to avoid developing problems with absorption.”

ANS: B

Feedback
A Insulin is not absorbed into the stomach.
B The American Diabetes Association Clinical Practice recommendations include rotating injections systematically at one site before progressing to another.
C Failure to rotate sites can result in lipohypertrophy or lipoatrophy.
D When administering subcutaneous insulin, aspiration should never be performed.

DIF: Cognitive Level: Application REF: 160
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

2. Which technique by the nurse is accurate when administering heparin to a thin, older adult patient?
A. Aspirate before injecting the medication.
B. Inject at a 45-degree angle.
C. Inject at a 90-degree angle.
D. Massage site following injection.

ANS: B

Feedback
A Heparin should never be aspirated.
B The skin may need to be pinched and a 45-degree angle used for thin individuals to avoid administration into the muscle.
C Subcutaneous injections are properly administered at a 45-degree angle.
D The injection site of heparin should never be massaged.

DIF: Cognitive Level: Application REF: 160
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

3. The nurse is preparing to administer kindergarten immunizations at the local health clinic. Which anatomic site would be best for the injection of the immunizations containing 0.5 mL?
A. Rectus femoris
B. Dorsogluteal
C. Deltoid
D. Ventrogluteal

ANS: C

Feedback
A Having the child disrobe is not efficient in this setting.
B Having the child disrobe is not efficient in this setting.
C The deltoid muscle is often used because of its easy access and it can tolerate 0.5 mL of medication volume.
D Having the child disrobe is not efficient in this setting.

DIF: Cognitive Level: Application REF: 163
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

4. A 65-year-old man who weighs 180 lb (81.8 kg) is to receive 1.5 mL of a viscous antibiotic by intramuscular injection. Which needle and syringe will be used?
A. 5/8-inch, 25-gauge needle with 5-mL syringe
B. 1-inch, 28-gauge needle with 4-mL syringe
C. 1 1/2-inch, 21-gauge needle with 3-mL syringe
D. 3-inch, 16-gauge needle with 1.5-mL syringe

ANS: C

Feedback
A This needle is too short and too small to administer a viscous medication.
B This needle is too small to administer a viscous medication.
C It is important to correlate the syringe size to the size of the patient and the tissue mass. The usual amount injected intramuscularly is 0.5 to 2 mL. Needle lengths commonly used for adults are 1 to 1 1/2 inches long. A longer needle may be used for a significantly obese adult. Commonly used needle gauges for IM injections are 20- to 22-gauge.
D This needle is too large and too long to administer medication to a patient this size.

DIF: Cognitive Level: Application REF: 161
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

5. Which is the preferred intramuscular site for injecting a 6-month-old child?
A. Dorsogluteal
B. Abdominal
C. Vastus lateralis
D. Deltoid muscle

ANS: C

Feedback
A The dorsogluteal muscle is not developed well enough in a child this age to provide a safe site for injection.
B The abdominal muscles are not appropriate for intramuscular injection.
C The vastus lateralis is generally the preferred IM site in infants because it has the largest muscle mass for that age group. The muscles are not well developed in other areas for this age group.
D The deltoid muscle is not developed well enough in a child this age to provide a safe site for injection.

DIF: Cognitive Level: Knowledge REF: 162
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

6. Which angle is appropriate when administering an IM medication in the dorsogluteal site to a 46-year-old obese man?
A. 45 degrees
B. 60 degrees
C. 75 degrees
D. 90 degrees

ANS: D

Feedback
A A 45-degree angle does not ensure that the needle will penetrate to the muscle in an obese patient.
B A 60-degree angle does not ensure that the needle will penetrate to the muscle in an obese patient.
C A 75-degree angle does not ensure that the needle will penetrate to the muscle in an obese patient.
D A 90-degree angle is used to reach the intramuscular area of the dorsogluteal site.

DIF: Cognitive Level: Application REF: 163
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

7. Which parenteral route has the longest absorption time?
A. Intradermal
B. Subcutaneous
C. Intramuscular
D. Intravenous

ANS: A

Feedback
A Absorption rate is determined by the proximity of the medication to the vascular system. Medication injected into an intradermal site is farther away from the vascular system than the other sites. Therefore, absorption in this site is the slowest.
B Subcutaneous tissue is more vascular than intradermal tissue.
C Intramuscular tissue is more vascular than intradermal tissue.
D Intravenous administration places medication directly into the vascular system.

DIF: Cognitive Level: Knowledge REF: 157
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

8. Which site is identified by the posterior superior iliac spine and greater trochanter?
A. Ventrogluteal
B. Dorsogluteal
C. Vastus lateralis
D. Rectus femoris

ANS: B

Feedback
A These are not the anatomic landmarks for the ventrogluteal site.
B The dorsogluteal site is identified by drawing an imaginary line from the posterior superior iliac spine to the greater trochanter of the femur. The injection is then administered at any point between the imaginary straight line and below the curve of the iliac crest (hipbone).
C These are not the anatomic landmarks for the vastus lateralis site.
D These are not the anatomic landmarks for the rectus femoris site.

DIF: Cognitive Level: Comprehension REF: 163
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

9. Which nursing action is accurate when administering an intramuscular injection using the Z-track method?
A. Use a 1-inch needle.
B. Add 0.5 mL of air to the syringe.
C. Vigorously massage the injection site.
D. Pinch up the skin.

ANS: B

Feedback
A This needle size may not ensure deep muscle penetration.
B Adding 0.5 mL of air ensures that the drug will clear the needle.
C Massaging the injection site could cause the medication to leak into the muscle tissue.
D The skin should be stretched, not pinched up.

DIF: Cognitive Level: Comprehension REF: 166
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

10. Which gauge needles are used for subcutaneous injections?
A. 14 to 16 gauge
B. 18 to 21 gauge
C. 22 to 24 gauge
D. 25 to 29 gauge

ANS: D

Feedback
A This needle size is used for administration of blood or large volumes of fluid in a short period of time.
B This needle size is used for routine parenteral fluid administration.
C This needle size is used for administering fluids or medication via small veins.
D Commonly used gauges for subcutaneous injection are 25 to 29 gauge.

DIF: Cognitive Level: Knowledge REF: 160
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity