Chapter 11: Parenteral Administration: Intradermal, Subcutaneous, and Intramuscular Routes My Nursing Test Banks

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

11. When is it acceptable to use the deltoid muscle as an injection site for infants?

a.

Medication is irritating.

b.

Dose is a long acting medication.

c.

Child is combative.

d.

Volume is quite small.

ANS: D

The deltoid site should be used in infants only when the volume is quite small, the medication is nonirritating, and the dose will be quickly absorbed. Irritating and long acting medications should be injected in deep muscle tissue such as the vastus lateralis. A combative child should be adequately restrained and injected in a fairly large muscle mass.

DIF: Cognitive Level: Comprehension REF: p. 164 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. Which action by the nurse is most accurate when administering an intradermal injection?

a.

Insert the needle at a 45-degree angle.

b.

Inject 0.1 mL.

c.

Use a 22-gauge needle.

d.

Wipe the site with alcohol after injection.

ANS: B

Small volumes, usually 0.1 mL, are injected. The needle is inserted at a 15-degree angle. A 26-gauge needle is used. After injection, the site should not be wiped with alcohol.

DIF: Cognitive Level: Application REF: p. 157 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. Which assessment by the nurse is most important to obtain prior to performing allergy sensitivity testing?

a.

Identify areas of loose connective tissue.

b.

Question the patient about frequency of exercise.

c.

Determine if the patient is using aspirin.

d.

Palpate and measure the size of induration.

ANS: C

It is important to determine if the patient has taken any antihistamines or anti inflammatory agents for 24 to 48 hours prior to allergy testing. Loose connective tissue is assessed prior to administering injections subcutaneously. Exercise routine is not significant prior to allergy testing. Palpation and measurement of the size of induration are done after the procedure.

DIF: Cognitive Level: Application REF: p. 157 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

14. The nurse administers a skin prick test (SPT) to a patient at 9 AM. The earliest time the nurse can expect to read the test is:

a.

the next day at 9 AM.

b.

by 9 PM the same day.

c.

by 9:10 AM the same day.

d.

one week from the date and time of administration.

ANS: C

The SPT can be read in 10 to 20 minutes after administration, depending on protocol.

DIF: Cognitive Level: Application REF: p. 159 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. The nurse cleansing the skin surface of a patient prior to injection will start at the:

a.

periphery and work inward in a back and forth motion.

b.

periphery and work inward in a cyclical motion.

c.

injection site and work outward in a straight line.

d.

injection site and work outward in a circular motion.

ANS: D

The skin surface is cleansed prior to injection starting at the injection site and working outward in a circular motion toward the periphery.

DIF: Cognitive Level: Application REF: p. 165 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

16. The nurse is preparing to administer allergy sensitivity testing to a patient. Which statement(s) pertain(s) to this type of administration? (Select all that apply.)

a.

Allergy sensitivity testing requires the intradermal route.

b.

Injections are made into the loose connective tissue.

c.

Equipment needed includes gloves, antiseptic pledget, metric ruler, and physicians order sheet.

d.

Record of previous injection sites is needed.

e.

The needle should be inserted at a 15-degree angle with the needle bevel up.

ANS: A, C, E

Allergy sensitivity testing requires the intradermal route. Before administering allergy testing, gathering of equipment and physicians orders are necessary. This route is injected into the dermal layer of skin, using a 15-degree angle. Connective tissue, having poor blood supply, is not appropriate for injection of medication. Previous injection sites would not factor into the decision about where to conduct allergy testing.

DIF: Cognitive Level: Comprehension REF: p. 157 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. Which statement(s) about administering medications parenterally is/are true? (Select all that apply.)

a.

Subcut absorption is slower than intradermal absorption.

b.

Two mL or less should be administered in a subcut site.

c.

The gluteal area is recommended for children.

d.

Needles 1 to 1 1/2 inches in length are common for IM injections.

e.

The scapular areas of the back may be used for intradermal injections.

ANS: B, D, E

No more than 2 mL of medication should be injected into a subcut site. Needle length of 1 to 1 1/2 inches is common for IM injections. The upper chest, scapular areas of the back, and the inner aspect of the forearms are commonly used as sites for intradermal injections. Subcutaneous absorption is faster than intradermal absorption. Because of the undeveloped muscle mass in children, the gluteal area is not recommended for IM injection.

DIF: Cognitive Level: Knowledge REF: pp. 157-167 OBJ: 1 | 2 | 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. The vastus lateralis muscle is appropriate for injections for which patient(s)? (Select all that apply.)

a.

Children younger than 3 years of age

b.

Elderly

c.

Debilitated

d.

Nonambulatory

e.

Ambulatory

f.

Healthy

ANS: A, E, F

Children younger than 3 years of age, ambulatory patients, and otherwise healthy patients may receive injections in the vastus lateralis. Elderly, debilitated, and nonambulatory patients may have reduced muscle mass in the vastus lateralis, and therefore poor absorption of injected medications.

DIF: Cognitive Level: Comprehension REF: p. 162 OBJ: 4 | 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

19. The nurse administers B12 IM to a patient in a long term care facility. After administering this medication, the nurse will: (Select all that apply.)

a.

carefully recap the needle.

b.

identify the patient.

c.

massage site of injection.

d.

dispose of the used needle according to policy.

e.

apply a small bandage to the site.

ANS: D, E

After administering an IM injection, the nurse should dispose of used needles according to policy and apply a small bandage to the site. Needles should never be recapped following use. The patient requires identification before the injection is given. After the needle is removed, gentle pressure should be applied to the site. Massage can increase the pain if the muscle mass is stressed by the amount of medication given.

DIF: Cognitive Level: Application REF: p. 162 | p. 165

OBJ: 3 TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

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