The appropriate needle gauge for intradermal injection is:
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Solution
Option D: Because an intradermal injection does not penetrate deeply into the skin, a small-bore 26G-27G needle is recommended. This type of injection is used primarily to administer antigens to evaluate reactions for allergy or sensitivity studies.
Options A, B, and C: A 20G needle is usually used for I.M. injections of oil-based medications; a 22G-25G needle for I.M. injections; and a 25G needle, for subcutaneous insulin injections.
The appropriate needle size for insulin injection is:
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Solution
Option D: A 25G, 5/8” needle is the recommended size for insulin injection because insulin is administered by the subcutaneous route.
Option A: An 18G, 1 ½” needle is usually used for I.M. injections in children, typically in the vastus lateralis.
Option C: A 22G, 1 ½” needle is usually used for adult I.M. injections, which are typically administered in the vastus lateralis or ventrogluteal site.
The mid-deltoid injection site is seldom used for I.M. injections because it:
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Solution
Option A: The mid-deltoid injection site can accommodate only 1 ml or less of medication because of its size and location (on the deltoid muscle of the arm, close to the brachial artery and radial nerve).
The correct method for determining the vastus lateralis site for I.M. injection is to:
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Solution
Option D: The vastus lateralis, a long, thick muscle that extends the full length of the thigh, is viewed by many clinicians as the site of choice for I.M. injections because it has relatively few major nerves and blood vessels. The middle third of the muscle is recommended as the injection site. The patient can be in a supine or sitting position for an injection into this site.
All of the following nursing interventions are correct when using the Z-track method of drug injection except:
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Solution
Option D: The Z-track method is an I.M. injection technique in which the patient’s skin is pulled in such a way that the needle track is sealed off after the injection. This procedure seals medication deep into the muscle, thereby minimizing skin staining and irritation. Rubbing the injection site is contraindicated because it may cause the medication to extravasate into the skin.
A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient’s skin. The most appropriate nursing action would be to:
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Solution
Option A: Initial sensitivity to penicillin is commonly manifested by a skin rash, even in individuals who have not been allergic to it previously. Because of the danger of anaphylactic shock, the nurse should withhold the drug and notify the physician, who may choose to substitute another drug.
Option C: Administering an antihistamine is a dependent nursing intervention that requires a written physician’s order.
Option D: Although applying cornstarch to the rash may relieve discomfort, it is not the nurse’s top priority in such a potentially life-threatening situation.
The most appropriate time for the nurse to obtain a sputum specimen for culture is:
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Solution
Option A: Obtaining a sputum specimen early in this morning ensures an adequate supply of bacteria for culturing and decreases the risk of contamination from food or medication.
Which of the following statements about chest X-ray is false?
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Solution
Option A: Pregnancy or suspected pregnancy is the only contraindication for a chest X-ray. However, if a chest X-ray is necessary, the patient can wear a lead apron to protect the pelvic region from radiation.
Option B: Jewelry, metallic objects, and buttons would interfere with the X-ray and thus should not be worn above the waist.
Option C: A signed consent is not required because a chest X-ray is not an invasive examination.
Option D: Eating, drinking and medications are allowed because the X-ray is of the chest, not the abdominal region.
After 5 days of diuretic therapy with 20mg of furosemide (Lasix) daily, a patient begins to exhibit fatigue, muscle cramping and muscle weakness. These symptoms probably indicate that the patient is experiencing:
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Solution
Option A: Fatigue, muscle cramping, and muscle weaknesses are symptoms of hypokalemia (an inadequate potassium level), which is a potential side effect of diuretic therapy. The physician usually orders supplemental potassium to prevent hypokalemia in patients receiving diuretics.
Option C: Anorexia is another symptom of hypokalemia.
Option D: Dysphagia means difficulty swallowing.
Which of the following white blood cell (WBC) counts clearly indicates leukocytosis?
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Solution
Option D: Leukocytosis is any transient increase in the number of white blood cells (leukocytes) in the blood. Normal WBC counts range from 5,000 to 100,000/mm3. Thus, a count of 25,000/mm3 indicates leukocytosis.