Chapter 35 - deWit Flashcards
When drawing up medication from a vial, the nurse would ?
Inject an equivalent amount of air into the vial for the medication to be withdrawn
A sign that an intradermal injection has been successfully given is when ?
A small bleb is evident at the injection site
Ways to decrease injection discomfort include (Select all that apply)
- Premedicate with an oral analgesic
- Use the smallest gauge needle that is appropriate
- Allow the alcohol on the skin to dry before giving the injection
- Inject the medication slowly and steadily
When using the leg of a child for an intramuscular injection, the area landmarks include ?
A hand’s breadth below the end of the greater trochanter
Different types of injection cause solutions to be absorbed at different rates. The advantage of an intramuscular injection over a subcutaneous injection is that the solution is absorbed more _____?
Rapidly
Many things can happen when drugs are mixed in a syringe. Adverse consequences may be (Select all that apply)
- A change in color
- Formation of a precipitate
- Rendering of one or both medications inactive
The proper technique for administering a Z-track injection is to ?
Pull the tissue at the site laterally, then insert the needle at a 90-degree angle
“Heparin sodium 5000 sub cut.” is ordered for an average-sized adult. Using a 25-gauge 5/8” needle, this medication should be injected into the ____________ at a _______ angle
Subcutaneous layer, 45-90 degree
Z-track method of injection is used for medications that are very _____ to the tissue
Irritating
Symptoms of anaphylactic shock include:
urticarial, bronchiolar constriction manifests as wheezing, difficulty breathing, edema, circulatory collapse
When a 5/8” needle is used for a subcutaneous injection, the angle of injection should be ?
45-90 degrees
Up to ____ mL of solution can be intramuscularly injected safely
3
When withdrawing medication from an ampule, a ____ needle should be used
Filter
Typical diluents for mixing drugs are ______ and ______
Sterile water, sterile normal saline
Because injected medications are irretrievable, it is especially important to check for _____ before giving the injection
Allergies
Regarding absorption, _____ solutions are absorbed more rapidly than those in an ____ suspension
Aqueous, oil
Safety syringes are used to prevent _______ and the possibility of ______ illness
Needle sticks, contracting contagious
Factors to consider when giving an intramuscular injection to an older patient are:
May have decreased muscle mass, the body of the muscle may have to be palpated and then grasped to ensure injection into the muscle mass, shorter needle than average needle may be used
To pull back on the syringe plunger to create suction
Aspirate
Slanted part of needle tip
Bevel
Visible elevation of the epidermis
Bleb
Small circular piece at the center
core
Fluid to dissolve solute
Diluents
Formation of fibrous tissue
Fibrosis
Scale of measurement
Gauge
Interior diameter of needle
Lumen
Area of hardened tissue
Induration
Not via the gastrointestinal tract
Parenteral
Solid material dissolved in solution
Solute
Red, elevated wheals
Urticaria
Small bottle
vial
Sticky or gummy
Viscous
Skin testing for reaction to various substances is performed using an _______ injection
Intradermal
If a patient is allergic to the medication, an injection may cause _________
Anaphylactic shock
Medications that are given by injection are termed ______ medications, as they do not enter the gastrointestinal tract
Parenteral
Medications such as hydroxyzine pamoate (Vistaril) should be given by the _________ method of injection because this medication is very irritating to subcutaneous tissue
Intramuscular
Very small amounts of medication such as adrenalin (Epinephrine) are given with a _____ syringe
Tuberculin
Absorption time for the medication is given by _______ injection is slower than that given intramuscularly
Subcutaneous
When mixing two medications together in the same syringe, you must first check drug ______
compatibility
An _______ injection is administered at a 90-degree angle
Intramuscular
Parenteral routes are used for medication administration for the following three reasons:
- Patient cannot take medication by mouth
- To hasten the action of the drug
- When digestive juices would counteract the effects of the drug if given oral route
When administering parenteral injection, the nurse must take the following precautions:
- Ensure accurate dose
- Select correct site to prevent damage to tissue
- Use sterile equipment and aseptic technique to prevent infection and sepsis
The preferred sites for subcutaneous injections are:
- Upper portion of the upper outer arm
* Anterior surface of thigh, abdomen or where there are no major blood vessels or nerves
Heparin is given subcutaneously in the _____ sites
Abdominal
When giving insulin and heparin, do not ______ before injecting the medication
Aspirate
An intramuscular injection can be safely given in the following sites:
- Deltoid
- Ventrogluteal
- Vastus lateralis
- Rectus femoris
When patients are receiving repeated injections you should ?
Rotate sites
To clear the needle of medication and to keep medication from flowing back up into the subcutaneous tissues, _____ technique is often used for intramuscular injections
Aspirates
When giving injections to children, it is important to provide ________ before, during, and after the injection
Emotional support
Indicate the type of injection that would be used at the ventrogluteal site
Intramuscular injection
Indicate the type of injection used: 1/4” 27-gauge needle
Subcutaneous injection
Indicate the type of injection used: TB syringe with 1/4” needle
Intradermal injection
Indicate the type of injection used: must form a bleb
Intradermal injection
Indicate the type of injection used: placed in tissue above the muscle layer
Subcutaneous injection
Indicate the type of injection used: May be placed in the vastus lateralis
Intramuscular injection
Indicate the type of injection used: 3 mL of medication
Subcutaneous injection
Indicate the type of injection used: tuberculin test
Intradermal injection
Indicate the order in which the following assessments should be made before giving an injection:
1) Verify the correct patient using at least two identifiers
2) Verbally inquire about medication allergies
3) Check the MAR for allergy designations
4) Compare the medication label with the order on the MAR
5) Choose the appropriate syringe and needle for the injection
6) Inspect the area of the chosen injection site
Most injectable medications are prepared as an ______ solution
Aqueous
Many antibiotics come as a powder and must be correctly _________
Reconstituted
Injection needles have a ______ tip to make going through the skin smoother and less painful
Beveled
It requires a certain amount of ______ to smoothly given an injection
Dexterity
When medications are mixed in a syringe, they must be ________
Calibrated
Many injectable medications now come in a unit dose _____
Vial
The majority of patients are at least a little _____ when they are to receive an injection
Apprehensive
The nurse must be careful not to cause a ________to him or herself when giving an injection to a patient
needle stick
what routes are used when medication cannot be taken by mouth or quick drug action is desired
parenteral routes
what can improper site selection cause
nerve, blood vessel, or tissue damage
what are the routes of parenteral medication
ID, subut, IM
what route deposits medication into the dermal layer of the skin
ID
what injections are placed beneath the dermis and above muscle; 0.05 to 1 mL of solution may be injected ?
subcutaneously
what are sites for IM injections - 4
ventrogluteal, deltoid, the vastus lateralis and the rectus femoris
3 mL of solution may be safely injected into the ?
venrogluteal, the vastus lateralis, and the rectus femoris IM sites in an adult
A 2- to 3- mL syringe is usually used for a ? injection with a ? - ? inch needle that is ? - ? gauge
IM; 1- to1 1/2-inch; 23 to 20 gauge
tuberculin and 2- to 3- mL syringes have two mesasurement scales. what are they
milliliters and minims
what is the minim scale used for
very small doses
what kind of needle is used to draw up medications from an ampule
filter needle
the selection of a gauge of needle depends on what
the viscosity of the fluid to be injected and the route of administration
when a repeat injection of a drug is given, assess for what?
side effects of the drug, previous site condition, and evidence of therapeutic effect before administration of the dose
Id injections are used for
allergy testing and the administration of the TST
always aspirate for blood before what kind of injection?
IM
what is the preferred site for IM injection in infants under the age of 12 months
vastus lateralis
what is the safest site to use in the adult?
ventrogluteal IM injection site
when is a Z-track technique used?
with particularly irritating medications to decrease pain and bruising by sealing the drug in the muscle tissue
what are some symptoms of anaphylactic shock
urticarial, bronchiolar constriction, edema, and circulatory collapse.
the pt is prescribed a med via parenteral route, but ask why cant I just take a pill. what do you say
digestive juices will counteract the effects of the drug
the nurse is preparing to give an average size adult pt an IM injection of 3mL of viscous medication. which equipment should the nurse use
5-mL syringe with a 20-gauge 1 1/2-inch needle
during an intramuscular injection, the pt moves as the nurse is withdrawing the needle and the nurse accidentally sustains a needle stick injury. what is the priority action
scrub the needle stick site with warm water and soap
the nurse is supervising a nursing student who is trying to withdraw 2mL of medication from an ampule. what are proper techniques
wrap neck of the ampule with an alcohol swab, taps the stem of ampule to dislodge medication that is trapped in the stem, inserts a filter needle into the ampule below the surface of the fluid.
a pt need an ID injection for a tuberculin skin test (TST) but he currently has bilateral forearm casts in place. what is the best alternative site?
lateral upper arm
which nursing diagnosis would be the priority if a pt had a severe anaphylactic reaction to a parenteral med
impaired gas exchange
the nurse must give an injection to a 7 year old what actions should you do
allow child to hold and examine a demonstration syringe, give brief explanation of what is to happen, instruct the child on a distraction tasks that he can do during the procedure
when the nurse is preparing a parentaeral injection medical asepsis in permissible for handling the
barrel of the syringe
the nurse must give an IM injection to an 8 month old. which injection site is the best choice for this pt
vastus lateralis
the nurse has just given the pt an injection. massaging the area is the appropriate nursing action for which medication?
morphine
