A nurse is administering an intramuscular injection to a client using the Z-track method.
Which of the following actions should the nurse take?
Release the skin before withdrawing the needle.
Insert at a 45° angle.
Withdraw the needle quickly.
Pull the skin laterally.
The Correct Answer is D
A. With the Z-track method, the skin is pulled laterally or to the side before the needle is inserted and released after the injection is administered to ensure the medication remains within the muscle and does not leak into the subcutaneous tissue.
B. The angle of insertion for intramuscular injections can vary depending on factors such as the client's body habitus and the length of the needle but is typically 90 degrees.
C. The needle should be withdrawn slowly and steadily to minimize tissue trauma and prevent medication leakage.
D. The Z-track method involves pulling the skin laterally or to the side before inserting the needle to create a zigzag pathway for the medication. This helps seal the needle track after the injection, reducing the risk of medication leakage into subcutaneous tissues.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While it may be necessary to notify risk management eventually, the immediate priority is to ensure the client's safety and well-being.
B. The nurse should promptly assess the client for signs and symptoms of an allergic reaction and initiate appropriate interventions as necessary.
C. Documentation of the medication error and allergic reaction should be completed after ensuring the client's immediate needs are addressed.
D. Administering an antidote may be appropriate in certain situations, but the nurse should first assess the client's condition and follow established protocols for managing allergic reactions.
Correct Answer is B
Explanation
A. Disconnecting the drainage tube can introduce bacteria and increase the risk of infection.
B. Maintaining the collection bag below the level of the bladder prevents backflow of urine and reduces the risk of infection.
C. Catheter size selection is based on individual client factors and is not directly related to infection prevention.
D. Allowing the drainage bag to overfill increases the risk of backflow and infection.
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