Basic Pharmacology For Nurses 16th Edition By Clayton – Test Bank

Chapter 11: Parenteral Administration: Intradermal, Subcutaneous, and Intramuscular 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
The American Diabetes Association Clinical Practice recommendations include rotating injections systematically at one site before progressing to another. Insulin is not absorbed into the stomach. Failure to rotate sites can result in lipohypertrophy or lipoatrophy. When subcutaneous (subcut) insulin is administered, aspiration should never be performed.

DIF: Cognitive Level: Application REF: p. 160 | p. 165
OBJ: 2 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
For thin individuals, the skin may need to be pinched and a 45-degree angle used to avoid administration into the muscle. Heparin should never be aspirated. Subcut injections are properly administered at a 45-degree angle. The injection site of heparin should never be massaged.

DIF: Cognitive Level: Application REF: p. 160 OBJ: 2
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
The deltoid muscle is often used because of its easy access and the fact that it can tolerate 0.5 mL of medication volume. Having the child disrobe is not efficient in this setting.

DIF: Cognitive Level: Application REF: p. 164 OBJ: 5
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 (IM) 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
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. A 5/8 inch, 25-gauge needle is too short and too small to administer a viscous medication. A 1 inch, 28-gauge needle is too small to administer a viscous medication. A 3 inch, 16-gauge needle is too large and too long to administer medication to a patient this size.

DIF: Cognitive Level: Application REF: p. 161 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

5. Which is the preferred IM site for injecting a 6-month-old child?
a. Dorsogluteal
b. Abdominal
c. Vastus lateralis
d. Deltoid muscle

ANS: 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. The dorsogluteal muscle is not developed well enough in a child this age to provide a safe site for injection. The abdominal muscles are not appropriate for IM injection. 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: p. 162 OBJ: 5
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
A 90 degree angle is used to reach the IM area of the dorsogluteal site. A 45-, 60-, or 75-degree angle does not ensure that the needle will penetrate to the muscle in an obese patient.

DIF: Cognitive Level: Application REF: p. 163 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

7. Which parenteral route has the longest absorption time?
a. Intradermal
b. Subcut
c. IM
d. Intravenous (IV)

ANS: 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. Subcut tissue is more vascular than intradermal tissue. IM tissue is more vascular than intradermal tissue. IV administration places medication directly into the vascular system.

DIF: Cognitive Level: Knowledge REF: p. 157 OBJ: 1
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
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).

DIF: Cognitive Level: Comprehension REF: p. 163 OBJ: 4
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

9. Which nursing action is accurate when administering an IM 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
Adding 0.5 mL of air ensures that the drug will clear the needle. A 1-inch needle may not ensure deep muscle penetration. Massaging the injection site could cause the medication to leak into the muscle tissue. The skin should be stretched, not pinched up.

DIF: Cognitive Level: Comprehension REF: p. 166 OBJ: 5
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

10. Which gauge needles are used for subcut injections?
a. 14 to 16 gauge
b. 18 to 21 gauge
c. 22 to 24 gauge
d. 25 to 29 gauge

ANS: D
Commonly used gauges for subcut injection are 25 to 29 gauge. Needles that are 14 to 16 gauge are used for administration of blood or large volumes of fluid in a short period of time. Needles that are 18 to 21 gauge are used for routine parenteral fluid administration. Needles that are 22 to 24 gauge are used for administering fluids or medication via small veins.

DIF: Cognitive Level: Knowledge REF: p. 160 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity