A nurse is caring for a client who is to receive a corticosteroid injection. The client states, "I am not taking that injection today." Which of the following responses should the nurse make?

Answer: C

Rationale:

A) Inject air into the vial with regular insulin in it:

Injecting air into the vial of regular insulin is part of the correct procedure but not the initial step. This action is typically performed after the NPH insulin vial has been handled, as part of the process to prevent contamination and maintain the correct insulin types.

B) Draw up the NPH insulin dose:

Drawing up the NPH insulin dose should follow the initial steps of air injection. It is important to manage the insulin types in the correct sequence to ensure that the regular insulin remains uncontaminated by the NPH insulin.

C) Inject air into the vial with NPH insulin in it:

Injecting air into the NPH insulin vial first helps to equalize the pressure and avoid contamination when drawing up the insulin. This step is crucial to ensure that the NPH insulin is not inadvertently mixed with the regular insulin, maintaining the integrity of each type.

D) Draw up the regular insulin dose:

Drawing up the regular insulin dose should occur after air has been injected into both vials. This ensures that the NPH insulin is not drawn into the regular insulin syringe, which could affect the medication's efficacy.

A) Aspirate the syringe prior to injecting the heparin:
Aspiration is not necessary when administering heparin subcutaneously because the medication is intended for subcutaneous tissue and not a blood vessel. Aspirating the syringe before injection could increase the risk of tissue trauma and bleeding.

B) Use the Z-track method to administer the medication:
The Z-track method is a technique used primarily for intramuscular injections to minimize medication leakage and staining of the skin. It is not typically used for subcutaneous injections, and using this method for heparin administration may not be appropriate or necessary.

C) Gently massage the site following the injection:
Massaging the site following a subcutaneous injection, particularly with anticoagulant medications like heparin, can increase the risk of bleeding or hematoma formation. Therefore, it is generally not recommended to massage the site after administering heparin subcutaneously.

D) Grasp skin between thumb and forefinger throughout the injection:
Grasping the skin between the thumb and forefinger during the injection creates tension on the skin, which helps to stabilize the tissue and reduce the risk of bleeding following the injection. This technique is commonly used when administering subcutaneous injections to minimize the likelihood of bleeding or bruising at the injection site.