Ch.34 Parenteral Medications (FON)

Question 1

Name the parts of a syringe.

Answer 1

Plunger
Barrel
Plain Tip
Needle Hub
Needle

Question 2

List factors to consider when selecting a syringe and needle.

Answer 2

• The type of medication
• Depth of tissue
• Volume of prescribed drug
• Viscosity of the drug
• The size of the client

Question 3

Explain the rationale for redesigning conventional syringes and needles.

Answer 3

Conventional syringes and needles are being redesigned to avoid needlestick injuries, thus reducing the risk of acquiring a blood-borne viral disease such as hepatitis B (HBV), hepatitis C (HCV), and HIV/AIDS.

Question 4

Name ways that pharmaceutical companies prepare parenteral drugs.

Answer 4

• Ampules: Sealed glass drug container
• Vials: A glass or plastic container of parenteral medication with a self-sealing rubber stopper.
• Prefilled Cartridges: A sealed glass cylinder of parenteral medication.

Question 5

Discuss an appropriate action before combining two drugs in a single syringe.

Answer 5

Exact amounts must be withdrawn from each drug container because once drugs are in the barrel of the syringe there is no way to expel one without expelling some of the other, also reference a drug reference compatibility chart because some drugs interact chemically when combined.

Question 6

List injection routes.

Answer 6

Intradermal Injections (Injections between the layers of the skin)

Subcutaneous Injections (Injections beneath the skin but above the muscle)

Intramusclar Injections (Injections in the muscle tissue)

Intravenous Injections (Injections instilled into veins)

Question 7

Identify common sites for intradermal, subcutaneous, and intramuscular injections.

Answer 7

• Intradermal Injections: A common site for an intradermal injection is the inner aspect of the forearm. Other areas that may be used are the back, posterior upper arm, and upper chest
• Subcutaneous Injections: The site with the fastest absorption rate is the abdomen, then, in order to the slowest: the outer back area of the upper arm, where it is fleshier; the outer areas of the thigh; and the “wallet area” of the buttocks.
• Intramuscular Injections: The four IM injection sites are named for the muscles into which the medications are injected: the ventrogluteal, the vastus lateralis, the rectus femoris, and the deltoid.

Question 8

Name types of syringes commonly used to administer an intradermal, subcutaneous, and intramuscular injection.

Answer 8

• Intradermal Injections
  
  • Tuberculin syringe
• Subcutaneous Injections
  
  • Insulin syringe for insulin only, tuberculin, or a pre-filled cartridge
• Intramuscular injection
  
  • 3-5 ml syringe are used to administer medication.

Question 9

Describe the angles of entry for intradermal, subcutaneous, and intramuscular injections.

Answer 9

• When giving an intradermal injection, the nurse instills the medication shallowly at a 10- to 15-degree angle of entry
• To reach subcutaneous tissue in a normal-sized or obese person who has a 2-in tissue fold when it is bunched, the nurse inserts the needle at a 90-degree angle.
  
  • For thin clients who have a 1-in fold of tissue, the nurse inserts the needle at a 45-degree angle
• When administering IM injections, nurses use a 90-degree angle for piercing the skin

Question 10

Discuss why most insulin combinations must be administered within 15 minutes of being mixed.

Answer 10

• To avoid equilibration
  
  • The loss of each insulin’s unique characteristics

Question 11

Describe techniques for preventing bruising when administering heparin subcutaneously.

Answer 11

• The nurse changes the needle after filling the syringe with the dose of heparin before injecting patient.
• The injection site is not cleaned with an alcohol wipe.
• The nurse does not aspirate the plunger.
• The needle is left in place for 5 seconds.
  
  • If bleeding or oozing occur following injection, press on site with gauze but do not rub because it can cause localized bleeding.

Question 12

Nurses draw an imaginary line at the ____________ when administering an injection in the deltoid site.

Answer 12

Axilla

Question 13

A(n) ____________ syringe holds 1 mL fluid and is calibrated in 0.01-mL increments.

Answer 13

Tuberculin

Question 14

When administering ____________ injections, nurses use a 90-degree angle for piercing the skin.

Answer 14

Intramuscular

Question 15

____________ is unnecessary when injecting insulin with an insulin pen because the needle is only 5-mm long and unlikely to enter a muscle.

Answer 15

Bunching

Question 16

There is a risk of damaging the ____________ nerve and artery if the deltoid site is not identified properly.

Answer 16

Radial

Question 17

Conventional syringes and needles are being redesigned to avoid _______________ injuries.

Answer 17

Needlestick

Question 18

____________ is the process of adding a diluent to a powdered substance before administering the drug parenterally.

Answer 18

Reconstitution

Question 19

____________ needles contain a membrane that acts as a barrier blocking the entrance of glass shards when withdrawing medication from a glass ampule.

Answer 19

Filter

Question 20

____________ is a hormone required by some clients with diabetes.

Answer 20

Insulin

Question 21

Identify and label the image.

Answer 21

The figure shows the ventrogluteal site for administering intramuscular injections.

Question 22

What are the names of the muscles used in this injection site?

Answer 22

The muscles in this injection site are the gluteus medius and the gluteus minimus, which are large and, therefore, can hold a fair amount of injected medication with minimal post injection discomfort.

Question 23

How is this site located to perform injections?

Answer 23

The palm of the hand is placed on the greater trochanter with the index finger on the anterior superior iliac spine.

The middle finger is moved as far as possible away from the index finger along the iliac crest.

The injection is done into the center of the triangle formed by the index finger, the middle finger, and the iliac crest.

Question 24

1 mL calibrated in 0.01 mL in minims

Answer 24

Intradermal

Question 25

2, 2.5, or 3 mL calibrated in 0.1-mL increments

Answer 25

Subcutaneous

Question 26

1 mL calibrated in units

Answer 26

Insulin

Question 27

3 or 5 mL calibrated in 0.2-mL increments

Answer 27

Intramuscular

Question 28

Presented here, in random order, are steps that occur during the withdrawal of medication from an ampule. Write the correct sequence in the boxes provided.

1. Tap the top of the ampule.
2. Tap the barrel of the syringe near the hub.
3. Insert the filter needle attached to a syringe into the ampule.
4. Snap the neck of the ampule away from your body.
5. Remove the filter needle and attach a sterile needle.

Answer 28

1. Tap the top of the ampule.
2. Snap the neck of the ampule away from your body
3. Insert the filter needle attached to a syringe into the ampule.
4. Tap the barrel of the syringe near the hub
5. Remove the filter needle and attach a sterile needle.

Question 29

What is the meaning of parenteral route?

Answer 29

The parenteral route is a route of drug administration other than oral or through the gastrointestinal tract.

This term is commonly used when referring to medications given by injection.

Question 30

What are the components of a syringe?

Answer 30

All syringes contain a barrel that holds the medication, a plunger located within the barrel that moves back and forth to withdraw and instill the medication, and a tip or hub.

Question 31

Why is a lower drug dose indicated in senior clients?

Answer 31

A lower dose of parenteral medications may be indicated for senior clients to prevent adverse effects.

Age-related changes and possible chronic diseases may impair the older person’s ability to absorb and metabolize medications.

Question 32

Why is it important to pinch tissue for an intramuscular injection?

Answer 32

Pinching the muscular tissue together may be needed to avoid striking bone when administering an intramuscular injection if the older person has decreased subcutaneous fat.

Question 33

Why are conventional syringes and needles being redesigned?

Answer 33

Conventional syringes and needles are being redesigned to avoid needlestick injuries, thus reducing the risk for acquiring a blood-borne viral disease such as hepatitis or AIDS.

Question 34

Why is it important to rotate insulin injection sites?

Answer 34

It is important to rotate insulin injection sites because, over time, the injection sites tend to undergo changes that interfere with insulin absorption.

To avoid lipoatrophy and lipohypertrophy, the sites are rotated each time an injection is administered.

Question 35

A nurse is caring for a client who is obese and has diabetes. The physician has ordered the nurse to administer a combined low dose of insulin to the client per the prescription.

What type of syringe should the nurse use to administer the insulin?

Answer 35

Typically, low-dose insulin syringes are used to deliver insulin in 30 to 50 units or less.

A standard insulin syringe can administer up to 100 units of insulin.

Question 36

A nurse is caring for a client who is obese and has diabetes. The physician has ordered the nurse to administer a combined low dose of insulin to the client per the prescription.

When should the nurse administer the combined low dose of insulin to the client?

Answer 36

The nurse should combine the different insulins just before administration.
When injected within 15 minutes of being combined, they act as if they had been injected separately. Otherwise, when mixed together, insulins tend to bind and become equilibrated.
This means that the unique characteristics of each are offset by those of the other.