Question 1
The nurse giving instructions about how to use the no-pinch method to inject subcutaneous insulin to a patient should instruct the family member to:
Your Answer:
Select a 5-mm needle and use a 90-degree angle
Rationale:
A 5-mm needle inserted at a 90-degree angle is appropriate for using the no-pinch method. Subcutaneous injections are never massaged. Rotating injections from major site to major site is no longer considered necessary to prevent hypertrophy. Patients may choose one anatomic area and systematically rotate sites within that region until all potential sites within the area are used, and either move to another anatomic site (e.g., thigh) or start the rotation over in the same anatomic area. If 5 cm of tissue can be pinched, the needle should be inserted at a 90-degree angle.
Question 2
A student nurse is administering enoxaparin (Lovenox®) to a patient by subcutaneous injection. Technique should be questioned when the nurse:
Your Answer:
Asks the patient if he knows why he is getting enoxaparin
Rationale:
Aspirating the medication before a subcutaneous injection is not necessary. Piercing a blood vessel during injection is rare, and aspiration may cause hematoma formation. Before heparin therapy, the patient's medication regimen should be assessed for drugs that interact with heparin (e.g., aspirin, nonsteroidal antiinflammatory drugs, cephalosporins, antithyroid agents, probenecid, and thrombolytics). The nurse should assess the patient's knowledge regarding the medication to be received. When heparin is administered subcutaneously, abdominal injection sites should be used. Anticoagulants may cause local bleeding and bruising when injected into areas such as arms and legs that are involved in muscular activity.
Question 3
When subcutaneous injections are given to small children, the maximum volume that may be administered in a single injection is:
Your Answer:
0.5 ml
Rationale:
Only amounts up to 0.5 ml may be administered subcutaneously to small children.
Question 4
When the nurse removes the needle after an injection is finished, his or her next step should be to:
Your Answer:
Cleanse the site with an antiseptic wipe per institution policy
Rationale:
Applying gentle pressure to the site aids absorption. The nurse should not massage the injection site; massaging can damage underlying tissue. A bandage, if needed, is applied after applying gentle pressure to the site and checking the site. Cleansing the site should be done before the injection is given.
Question 5
When giving a subcutaneous injection to a patient who is obese, the nurse should give the injection:
Your Answer:
At a 45-degree angle
Rationale:
Body weight and amount of adipose tissue influence the choice of needle length and angle of insertion. A 25-G, ½- to ⅝-inch-inch (1.3 to 1.6-cm) needle inserted at a 45-degree angle is appropriate for a patient of normal size. For patients who are obese, the nurse can pinch the tissue and use a longer needle to insert through the fatty tissue reaching the base of the skin fold; the correct angle of injection is 90 degrees.
Question 6
The nurse choosing the best injection site for a subcutaneous heparin injection for a patient with cachexia and little peripheral subcutaneous tissue correctly selects the:
Your Answer:
Upper thigh
Rationale:
The upper abdomen is the best injection site for a patient with cachexia and little peripheral subcutaneous tissue. The abdomen usually contains a larger amount of subcutaneous tissue than the peripheral areas of the body. Anticoagulants may cause local bleeding and bruising when injected into areas involved in muscular activity, such as arms and legs.
Question 7
When injecting LMW heparin, the nurse should inject:
Your Answer:
In the upper thigh
Rationale:
When LMW heparin is administered subcutaneously, a site on the right or left side of the abdomen, at least 5 cm away from umbilicus, should be chosen. Injecting LMW heparin on the side of the abdomen helps decrease pain and bruising at the injection site. Anticoagulants may cause local bleeding and bruising when injected into areas involved in muscular activity, such as arms and legs