Chapter 35: Administering Intradermal, Subcutaneous, and Intramuscular Injections My Nursing Test Banks

Chapter 35: Administering Intradermal, Subcutaneous, and Intramuscular Injections

Test Bank

MULTIPLE CHOICE

1. When the 8-year-old child complains that he does not want to have a shot, the nurse explains that the use of a parenteral route:

a.

is the best way to give medicine.

b.

will hasten the action of the drug.

c.

will take less medicine to make him well.

d.

will be painless because the needles are so sharp.

ANS: B

The parenteral route will hasten the action of the drug. Although the equipment is better, there is still some pain involved in a parenteral application. The parenteral method is not always the best way to administer a drug.

DIF: Cognitive Level: Application REF: p. 671 OBJ: Theory #2

TOP: Medication Administration: Parenteral

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

2. To ensure the proper administration of a tuberculin test, the nurse will:

a.

use a 3-mL syringe.

b.

choose a 21-gauge, 1-inch needle.

c.

insert the needle at a 30-degree angle.

d.

inject slowly to form a bleb.

ANS: D

An intradermal injection should be done using a 1-mL syringe with a 25-, 27-, or 29- gauge needle that is 5/8-inch long. The needle is inserted at a 15-degree angle, and medication is injected slowly to form a bump or a bleb underneath the skin.

DIF: Cognitive Level: Application REF: p. 682, Skill 35-1

OBJ: Theory #1 TOP: Medication Administration: Intradermal

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

3. The best angle to insert the needle to administration an subcutaneous injection is at an angle of _____ degrees.

a.

45 to 90

b.

30 to 45

c.

15 to 30

d.

5 to 15

ANS: A

The needle is inserted at a 45- or 90-degree angle depending on the needle length and the size of the patient.

DIF: Cognitive Level: Comprehension REF: p. 672, 686, Skill 35-2

OBJ: Theory #1 TOP: Medication Administration: Subcutaneous

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

4. The nurse computes the dose of medication as 2.4 million units of penicillin to be delivered in 4 mL. The nurse should:

a.

give the 4 mL using a 5-mL syringe.

b.

inform the charge nurse that the dose is too large to be given IM.

c.

divide the dose into two 3-mL syringes and give as a divided dose.

d.

ask the physician if another drug can be used.

ANS: C

The maximum number of milliliters that can be injected into the dorsogluteal muscle is 3 mL. If the person has small muscle mass, or if the dose exceeds 3 mL, the dose should be divided into two doses.

DIF: Cognitive Level: Analysis REF: p. 688 OBJ: Theory #1

TOP: Intramuscular Medication Administration

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

5. The nurse understands that the only part of the syringe that can be touched and not contaminated is the:

a.

needle.

b.

outside of the barrel.

c.

sides of the plunger.

d.

tip of the syringe.

ANS: B

The needle, inside of the barrel, sides of the plunger, and tip of the syringe must be kept sterile.

DIF: Cognitive Level: Knowledge REF: p. 673 OBJ: Clinical Practice #2

TOP: Injection Equipment KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

6. A nurse has just administered a medication to a patient using a syringe that is not a safety syringe. To dispose of the needle and syringe safely, the nurse should:

a.

recap the needle and dispose of it in the trash receptacle.

b.

recap the needle and dispose of it in the sharps container.

c.

leave the needle uncapped and dispose of it in the trash receptacle.

d.

leave the needle uncapped and dispose of it in the sharps container.

ANS: D

Needles are not to be recapped and should be deposited in the sharps container.

DIF: Cognitive Level: Application REF: p. 675, Safety Alert

OBJ: Clinical Practice #2 TOP: Preventing Needle Sticks

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

7. When the nurse is preparing to draw medication from an ampule, the proper procedure is to:

a.

allow medication to float freely in the body, neck, and stem.

b.

wrap the neck with a gauze or alcohol sponge to the open ampule.

c.

break the ampule so that it opens toward her.

d.

inject air into the ampule to ease the withdrawal of the medication.

ANS: B

The medication should rest in the body of the ampule before being withdrawn, and the neck should be wrapped to protect the nurse from glass cuts when the ampule is snapped open.

DIF: Cognitive Level: Application REF: p. 677, Clinical Cues

OBJ: Clinical Practice #3 TOP: Using Ampules

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

8. When withdrawing medication from an ampule, the best needle to use is a _____ needle.

a.

beveled

b.

1-inch

c.

1-inch

d.

filter

ANS: D

Medication should be withdrawn from an ampule using a filter needle, which prevents small glass fragments from being drawn into the syringe.

DIF: Cognitive Level: Application REF: p. 677 OBJ: Clinical Practice #3

TOP: Medication via Ampule KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

9. The nurse performs the proper technique when withdrawing medication from the vial by:

a.

wiping the rubber stopper with a povidone-iodine swab.

b.

inserting the needle into the vial at a 90-degree angle.

c.

injecting into the vial an amount of air that is equal to the dose.

d.

keeping the needle above the level of solution while withdrawing into the syringe.

ANS: C

The vial should be wiped with an alcohol swab before use, the needle should be inserted at a slight lateral angle to avoid coring the rubber stopper, and an amount of air equal to the dose should be injected into the vial, while the needle is kept below the level of the solution to withdraw the dose.

DIF: Cognitive Level: Application REF: p. 679, Steps 35-5

OBJ: Clinical Practice #3 TOP: Withdrawing Medication from a Vial

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

10. A patient has an order to receive two intramuscular injections in the same syringe. The nurse should initially:

a.

determine if the two medications are compatible in the same syringe.

b.

obtain a larger syringe that will accommodate both medications.

c.

select two syringes to give the medications separately.

d.

ask the patient whether he would prefer one or two injections.

ANS: A

The first step is to determine whether the two medications are compatible in the same syringe.

DIF: Cognitive Level: Analysis REF: p. 679, Clinical Cues

OBJ: Clinical Practice #5 TOP: Compatibility of Medications

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

11. A patient has an order to receive a mixture of short- and long-acting insulin. The first step to properly draw them up in the same syringe is to:

a.

shake both vials vigorously before use.

b.

inject air into the short acting clear insulin.

c.

withdraw the short acting clear insulin.

d.

inject air into the long acting cloudy insulin.

ANS: D

The vials should be rolled gently to mix the insulin suspension evenly, but they should not be shaken. Air is injected first into the long-acting cloudy insulin vial and then into the short-acting clear insulin vial.

DIF: Cognitive Level: Analysis REF: p. 680, Steps 35-4

OBJ: Clinical Practice #5 TOP: Combining Short- and Long-Acting Insulin

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

12. A nurse has opened and used part of a new multidose vial. The nurse should ______ the vial.

a.

write the current date on

b.

wipe the top of

c.

check the expiration date of

d.

replace the plastic top that covered

ANS: A

Before replacing a newly opened multidose vial in the medication storage area, the nurse should write the date the vial was opened, because out-of-date medication can chemically change.

DIF: Cognitive Level: Application REF: p. 679, Steps 35-3

OBJ: Clinical Practice #3 TOP: Multidose Vial Tips

KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment

13. When reinforcing instructions to a patient who will self-administer insulin injections at home, it is important to remind the patient to:

a.

always use a new insulin vial with each dose.

b.

rotate injection sites systematically.

c.

use a tuberculin syringe to draw up insulin.

d.

aspirate before injecting the insulin.

ANS: B

The patient should rotate injection sites systematically to promote absorption and to decrease tissue irritation.

DIF: Cognitive Level: Application REF: p. 684 OBJ: Clinical Practice #11

TOP: Self Administering Insulin KEY: Nursing Process Step: N/A

MSC: NCLEX: Health Promotion and Maintenance

14. The nurse has an order to administer an injection of purified protein derivative (PPD) by the intradermal route. The maximum amount of medication that can be given using this route is _____ mL.

a.

0.1

b.

0.75

c.

0.50

d.

0.2

ANS: A

The maximum dose that can be given via the intradermal route is 0.1 mL.

DIF: Cognitive Level: Knowledge REF: p. 682, Skill 35-1

OBJ: Theory #7 TOP: Mantoux Test

KEY: Nursing Process Step: Planning MSC: NCLEX: Safe Effective Care Environment

15. A nurse has administered a Mantoux skin test to a patient in the outpatient clinic at 9:00 AM on Monday. The patient should be scheduled to return to the clinic to have the result read:

a.

late Monday afternoon.

b.

late Tuesday afternoon.

c.

any time on Wednesday.

d.

any time on Friday.

ANS: C

The results of the Mantoux skin test should be read within 48 to 72 hours after injection.

DIF: Cognitive Level: Comprehension REF: p. 682, Skill 35-1

OBJ: Clinical Practice #8 TOP: Tuberculosis Testing

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

16. A hospitalized patient has an order for subcutaneous heparin. The best location to administer this medication is the:

a.

upper arm.

b.

anterior thigh.

c.

buttock.

d.

abdomen.

ANS: D

The optimal site for heparin injection is the abdomen, because this area is not involved in muscular activity, as are the arms, buttocks, and legs.

DIF: Cognitive Level: Knowledge REF: p. 688, Box 35-3

OBJ: Clinical Practice #8 TOP: Heparin Subcutaneous Injection

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

17. When administering an intramuscular injection to an adult patient using the ventrogluteal site, the nurse should use which landmark to locate the area for injection?

a.

The lower end of the trochanter and the knee

b.

The upper end of the trochanter and the knee

c.

The head of the trochanter and the posterior iliac spine

d.

The head of the trochanter and the anterior iliac spine

ANS: D

The head of the trochanter and the anterior iliac spine are the landmarks used to give an injection in the ventrogluteal site. The ventrogluteal site is the safest in regard to possible injury to the patients sciatic nerve.

DIF: Cognitive Level: Comprehension REF: p. 690, Skill 35-3

OBJ: Theory #10 TOP: Landmarks for Injection

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: reduction of risk

18. When administering an intramuscular injection for a 4-year-old child, the best site to use is the:

a.

gluteus medius.

b.

vastus lateralis.

c.

ventrogluteal.

d.

dorsogluteal.

ANS: B

The vastus lateralis is the best choice for children younger than 5 years old, because the gluteal muscle is not well developed.

DIF: Cognitive Level: Comprehension REF: p. 692 OBJ: Clinical Practice #7

TOP: Vastus Lateralis Site KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: reduction of risk

19. The most effective nursing actions to decrease discomfort to the patient during a parenteral injection would be:

a.

inserting the needle while the skin is still wet from the alcohol wipe.

b.

asking the patient to look at the injection site for learning purposes.

c.

using the smallest gauge needle that is appropriate for the site.

d.

removing the needle slowly to avoid damaging the tissue.

ANS: C

Using the smallest gauge needle that is appropriate for the site is one way to decrease patient discomfort.

DIF: Cognitive Level: Comprehension REF: p. 693, Box 35-4

OBJ: Clinical Practice #9 TOP: Parenteral Injection

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: basic care and comfort

20. A patient has a medication order for iron dextran (Imferon) to be given using the Z-track technique. The rationale for using this method is to:

a.

avoid medication irritation.

b.

avoid tissue scarring.

c.

cause less painful method.

d.

protect the sciatic nerve.

ANS: A

Z-track technique should be used with injection of this medication, because it creates a slanted needle track and avoids seepage of the medication back into subcutaneous or skin layers.

DIF: Cognitive Level: Comprehension REF: p. 694, Skill 35-5

OBJ: Theory #2 TOP: Z Track Technique KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

21. A patient asks why the clinic nurse asked him to remain in the clinic for 30 minutes after the injection of penicillin. The nurse explains that it is part of the standards of care to monitor for:

a.

any pain reaction.

b.

bleeding at the site.

c.

infection at the site.

d.

any allergic reaction.

ANS: D

The nurse should plan to monitor this patient for allergic response for 30 minutes after giving the first dose of a medication.

DIF: Cognitive Level: Application REF: p. 694, Safety Alert

OBJ: Clinical Practice #6 TOP: Allergic Reaction to Parenteral Injection

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22. When preparing to reconstitute a drug from a powder form, the nurse should first:

a.

use sterile water.

b.

vigorously shake the powder prior to reconstituting drug.

c.

follow directions on label for diluent to use.

d.

discard the vial and the unused medication.

ANS: C

Instructions for the diluent should be followed from the directions on the label.

DIF: Cognitive Level: Application REF: p. 678 OBJ: Clinical Practice #4

TOP: Reconstitution KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

23. Which medication order should be documented in the MAR and in the nurses notes after it is given?

a.

Digoxin 0.25 mg PO at 9:00 AM

b.

Demerol 75 mg IM PRN pain

c.

Lasix 40 mg PO twice daily

d.

KCl 20 mEq PO daily

ANS: B

PRN and STAT orders are recorded in both the MAR and nurses notes along with the reason why the medication was given, the result, and the duration of effect of medication.

DIF: Cognitive Level: Application REF: p. 695 OBJ: Clinical Practice #11

TOP: Documentation KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

24. A nurse giving a subcutaneous injection will select a:

a.

3-mL syringe and 22-gauge, 1-inch needle.

b.

3-mL syringe and 18-gauge, 1-inch needle.

c.

3-mL syringe and 25-gauge, 5/8-inch needle.

d.

3-mL syringe and 20-gauge, 1-inch needle.

ANS: C

For subcutaneous injection, it is best to use a 25-gauge, 5/8-inch needle.

DIF: Cognitive Level: Application REF: p. 672 OBJ: Clinical Practice #1

TOP: Needle and Syringe Size KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: basic care and comfort

25. The nurse is teaching a patient who weighs 325 pounds on how to administer a subcutaneous would suggest that the patient would:

a.

require a longer needle because of his weight.

b.

experience a faster response to the medication.

c.

use a 15-degree angle to inject the medication.

d.

need extra pressure at the injection site to prevent bleeding.

ANS: A

For the obese patient, the needle length should be longer than the needle length for a thin person because of excess fatty layers.

DIF: Cognitive Level: Application REF: p. 674, Clinical Cues

OBJ: Clinical Practice #1 TOP: Subcutaneous Injection

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

26. The nurse may refuse to carry out an order for a placebo if the:

a.

medication is labeled as a placebo.

b.

nurse has religious grounds for refusing.

c.

placebo is to be delivered by a parenteral route.

d.

patient is unaware that the medication is a placebo.

ANS: D

The nurse is ethically obligated to refuse to give a placebo if the patient has not been informed that the medication is a placebo.

DIF: Cognitive Level: Comprehension REF: p. 672, Legal/Ethical

OBJ: Theory #1 TOP: Placebo KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

27. When administering heparin, the nurse will avoid:

a.

using the lower abdomen as an injection site.

b.

rotating sites.

c.

massaging area for more than 3 seconds.

d.

aspirating after injection.

ANS: D

After the insertion of heparin, the nurse should not aspirate because this practice tends to increase bruising.

DIF: Cognitive Level: Application REF: p. 688, Box 35-5

OBJ: Theory #1 TOP: Heparin Injection

KEY: Nursing Process Step: Application

MSC: NCLEX: Physiological Integrity: pharmacological therapies

COMPLETION

28. The IM injection site recommended for infants under 12 months of age is the ____________.

ANS:

vastus lateralis

The vastus lateralis muscle is the site of choice for infants under 12 months for IM injections.

DIF: Cognitive Level: Knowledge REF: p. 692 OBJ: Theory #2

TOP: Medication Administration KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

29. A drug that has no actual pharmacologic effect is called a(n) __________.

ANS:

placebo

A drug that has not pharmacologic effect is called a placebo. The use of the fake drugs is unethical if the patient is unaware that placebos are being used.

DIF: Cognitive Level: Knowledge REF: p. 672 OBJ: Theory #1

TOP: Placebo KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

MULTIPLE RESPONSE

30. When reconstituting a drug from a powder, the nurse will: (Select all that apply.)

a.

confirm the type of diluent required.

b.

use only a 23-gauge needle to inject a reconstituted drug.

c.

thoroughly mix solute with diluent.

d.

roll the solute between hands to warm powder.

e.

label the drug as to the amount of medication per volume after dilution.

ANS: A, C, E

After confirming the type of diluent required, the solute must be mixed thoroughly with the recommended diluent, then labeled as to the amount of medication per volume after dilution.

DIF: Cognitive Level: Application REF: p. 678 OBJ: Clinical Practice #4

TOP: Mixing Drug from Powder KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

OTHER

31. You are preparing to mix short-acting and long-acting insulin. Prioritize these steps accordingly. (Separate letters with a comma and space as follows: A, B, C, D, E, F.)

A. Withdraw prescribed amount of short-acting insulin.

B. Inject air into short-acting insulin.

C. Check medications with MAR using three medication checks.

D. Choose and prepare site before injection.

E. Withdraw prescribed amount of long-acting insulin.

F. Inject air into long-acting insulin.

ANS:

C, F, B, A, E, D

These are the proper steps to take when mixing short- and long-acting insulin in one syringe.

DIF: Cognitive Level: Analysis REF: p. 689, Steps 35-2

OBJ: Clinical Practice #5

TOP: Mixing Short and Long Acting Insulin in One Syringe

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

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