Chapter 37 Administering Intradermal, Subcutaneous, and Intramuscular Medications

Chapter 37  Administering Intradermal, Subcutaneous, and Intramuscular Medications

Complete Chapter Questions And Answers
 

Sample Questions

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is providing care for a 32-year-old with suspected bowel obstruction who is receiving intramuscular injections of narcotic pain medication. The patient states, “I hate shots. Why can’t I just take a pill?” The best response by the nurse is
A.
“We want to avoid giving you medication that you have to digest.”
B.
“By giving the pain medication this way, it will last longer.”
C.
“Narcotic medications are destroyed by the acid in your stomach.”
D.
“The drug will be absorbed more slowly this way.”

____ 2. The nurse is teaching a 64-year-old with newly diagnosed diabetes to manage diabetes and insulin provision. The best action by the nurse is to
A.
Have the patient practice injecting his or her thigh with an empty syringe.
B.
Encourage the patient to identify a family member who will be giving the insulin shots.
C.
Obtain small insulin syringes that the patient can use to draw up the insulin.
D.
Instruct the patient to attend a diabetic support group that is offered on a monthly basis.

____ 3. The student nurse is preparing to provide meperidine (Demerol) 25 mg IM for pain. The pyxis is loaded with prefilled meperidine 50 mg syringes. An intervention by the instructor would be required if the student nurse
A.
Obtains a Carpuject® system to administer the medication.
B.
Recaps the needle after the injection.
C.
Wastes 25 mg of the meperidine prior to administration.
D.
Unscrews the syringe from the holder before discarding in the sharps container.

____ 4. The nurse is preparing to provide a subcutaneous injection. The nurse’s technique would include
A.
Pointing the bevel of the needle up before piercing the skin.
B.
Selecting a 14 g, 11/2” needle.
C.
Placing the total dose of 2.5 mL of medication in one syringe.
D.
Donning sterile gloves.

____ 5. The nurse is preparing to reconstitute a medication in a multiple-dose vial. The nurse understands that the most essential step in this process is
A.
Wiping the rubber stopper of the vial with alcohol before and after needle insertion.
B.
Instilling the accurate amount of diluents into the vial.
C.
Using a filtered needle to draw up the medication.
D.
Instilling air into the vial before withdrawing medication.

Chapter 37. Administering Intradermal, Subcutaneous, and Intramuscular Medications
Answer Section

MULTIPLE CHOICE

1. ANS: A

Feedback
A
Bypassing the gastrointestinal tract and thereby preventing gastrointestinal irritation is one benefit of parenteral therapy. Chapter Objective: Explain the significance of first-pass metabolism.
B
Parenteral therapy has a more rapid onset time compared to the oral route.
C
Narcotics can be taken orally.
D
Parenteral therapy will actually be absorbed more quickly than an oral medication.

PTS: 1 REF: Chapter: 37 | Page: 880 OBJ: Chapter Objective: 37-2
KEY: Content Area: Medication Administration | Integrated Process: Communication and Documentation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

2. ANS: C

Feedback
A
The patient should practice on a pillow or orange rather than subjecting herself to numerous injections that are not necessary.
B
It will be important for the patient to be able to provide her own insulin.
C
The smaller size that holds only 0.3 mL is best for children who need very small doses of insulin and for people with poor eyesight. The calibrations are printed in a larger font, making it easier for patients with impaired vision to see the numbers more accurately. Chapter Objective: Select appropriate needle gauge and length for the different routes of administration in the various injection sites.
D
This will help provide emotional support but will not achieve the goal of patient teaching at this time.

PTS: 1 REF: Chapter: 37 | Page: 882 OBJ: Chapter Objective: 37-8
KEY: Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

3. ANS: B

Feedback
A
Prefilled injection systems like Carpuject® (Abbott) and Tubex® (Wyeth-Ayerst) are designed for safe and quick loading and unloading.
B
Safety: The nurse should not recap the needle. Chapter Objective: Identify appropriate safety measures related to administration of injections.
C
The order is for Demerol 25 mg only, making it necessary to waste the other 25 mg of the prefilled 50-mg syringe.
D
After using the cartridge, the nurse should unscrew it from its holder and drop it vertically into a disposal container.

PTS: 1 REF: Chapter: 37 | Page: 883 OBJ: Chapter Objective: 37-11
KEY: Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

4. ANS: A

Feedback
A
The bevel should always face upwards when piercing the skin. Chapter Objective: Select appropriate needle gauge and length for the different routes of administration in the various injection sites. Describe proper injection technique for intradermal, subcutaneous, and intramuscular injections, including Z-track.
B
A smaller gauge, from 14 g (2.1 mm) to 20 g (0.9 mm), has a larger diameter and because of this, it is required for viscous, or thick, medications.
C
The maximum volume for subcutaneous injection according to most facility policies is 1 mL to 2 mL.
D
Asepsis is a primary concern when handling syringes and needles, but sterile gloves are not needed.

PTS: 1 REF: Chapter: 37 | Page: 884
OBJ: Chapter Objectives: 37-8| Chapter Objectives: 37-9
KEY: Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application

5. ANS: B

Feedback
A
It is not necessary to wipe the rubber stopper after needle insertion.
B
The nurse should review the drug insert for proper diluent, volume, and instructions for reconstitution. This will ensure accurate dosing. Chapter Objective: Discuss diluents and any restrictions for use related to various age groups.
C
This is not necessary with a vial; it is used for drawing medication up from an ampule.
D
This is a recommended practice, but is not the highest priority.

PTS: 1 REF: Chapter: 37 | Page: 887 OBJ: Chapter Objective: 37-16
KEY: Content Area: Medication Administration | Integrated Process: Nursing Process/Implementation | Client Need: Pharmacological and Parenteral Therapies | Cognitive Level: Application