A nurse is preparing to administer a medication to a client.

Complete the following sentence by using the lists of options.

The nurse should first address the client's

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followed by the client's

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.

Enoxaparin is a low-molecular-weight heparinused for the prophylaxis and treatment of venous thromboembolism. It functions by potentiating antithrombin 3 to inhibit factor Xa and thrombin. This medication is administered via subcutaneous injection, typically into the anterolateral or posterolateral abdominal wall. Proper technique is vital to ensure therapeutic absorption and to minimize the risk of localized hematoma or tissue trauma at the site.

Rationale:

A. Pinchingthe skin during subcutaneous administration ensures that the medication is deposited into the adipose tissuelayer rather than the underlying muscle. This technique helps lift the subcutaneous fat away from the muscle fascia, which is critical for the slow, consistent absorption of enoxaparin. It also decreases the risk of accidental intramuscular injection, which could lead to rapid absorption and increased bleeding.

B. Prefilled syringes of enoxaparin are specifically manufactured with a small nitrogen air bubblethat should not be expelled before administration. This air bubble serves to "seal" the medication into the subcutaneous tissue as the needle is withdrawn, preventing leakage into the needle track. Expelling this bubble can result in an incomplete dose and increases the likelihood of localized skin irritation or bruising.

C. Enoxaparin should not be injected into the muscle, as intramuscular administrationcan cause significant pain and the formation of large hematomas due to the high vascularity of muscle tissue. The preferred site for self-administration is the abdomen, specifically the "love handle" area. Using the upper arm muscle would be clinically inappropriate and would deviate from the evidence-based standards for low-molecular-weight heparin delivery.

D. Site rotationis a fundamental principle of subcutaneous therapy to prevent the development of lipodystrophyor localized tissue hardening. Repetitive injections in the exact same location can impair the absorption of the anticoagulant over the 2-week course. By alternating between different quadrants of the abdominal wall, the nurse ensures that the skin and underlying fat remain healthy and capable of absorbing the drug.

E. Inserting the needle at a 90-degree angleis the standard procedure for subcutaneous injections when an adequate skin fold can be pinched. This vertical approach ensures that the needle tip reaches the deep subcutaneous layer where enoxaparin is best absorbed. Using a 90-degree angle provides a consistent depth of delivery, which is essential for maintaining the predictable pharmacokinetic profileof this specific anticoagulant medication.

F. The client must be explicitly instructed not to rubor massage the site following the injection of enoxaparin. Rubbing the area can cause mechanical trauma to the microvasculature that has already been sensitized by the anticoagulant, leading to significant ecchymosisand hematoma formation. Maintaining gentle pressure without movement is the correct method to minimize localized bleeding without causing further tissue damage or discomfort.

Diazepam is a long-acting benzodiazepinethat enhances the inhibitory effect of gamma-aminobutyric acid(GABA) within the central nervous system. It is utilized for procedural sedation to induce anxiolysis and amnesia. Its primary safety concern involves dose-dependent depression of the medullaryrespiratory centers.

Rationale:

A.Fever is not a recognized adverse effect of diazepam administration. Benzodiazepines typically do not interfere with the hypothalamic thermoregulatory center to cause an elevation in body temperature. If a client develops a fever during sedation, the nurse should investigate other causes such as an underlying infection or a reaction to a different pharmacological agent.

B.Respiratory depression is the most critical adverse effect to monitor during diazepam administration for moderate sedation. As a central nervous system depressant, diazepam can significantly decrease the respiratory rate and tidal volume, leading to hypoxia or apnea. The nurse must continuously monitor oxygen saturation and capnography to ensure the patient maintains adequate spontaneous ventilation and airway patency.

C.Hypertension is unlikely to occur with diazepam; rather, the drug often causes a slight decrease in blood pressure due to reduced anxiety and systemic vasodilation. Benzodiazepines do not stimulate the sympathetic nervous system. Monitoring for hypotension and bradycardia is more appropriate when assessing the hemodynamic stability of a client undergoing moderate sedation with this agent.

D.Hyperreflexia is an exaggerated reflex response that is inconsistent with the pharmacological profile of benzodiazepines. Diazepam acts as a muscle relaxant and anxiolytic, which typically results in diminished or normal reflexes. Hyperreflexia is more commonly associated with upper motor neuron lesions or certain drug withdrawal states rather than acute sedation with GABAergic medications.