A nurse is preparing to administer heparin subcutaneously to an obese client who has a deep vein thrombosis. Which of the following actions should the nurse take?
Select a 22-gauge needle for heparin administration.
Insert the needle at a 90° angle.
Massage the injection site after administering the heparin.
Aspirate for a blood return prior to injecting the heparin.
The Correct Answer is B
B. Subcutaneous injections are generally administered at a 45° or 90° angle, depending on the amount of subcutaneous tissue present. In obese clients, there is typically more subcutaneous tissue, so inserting the needle at a 90° angle may be necessary to ensure proper medication absorption.
A. A smaller gauge needle (such as 25 or 26 gauge) is usually more appropriate for subcutaneous injections to minimize discomfort and tissue trauma, especially in obese clients where there is more subcutaneous tissue.
C. Massaging the injection site after administering heparin is not recommended. It can cause discomfort, bruising, and potentially alter the absorption rate of the medication. The injection site should be gently
pressed with a dry gauze pad after withdrawal of the needle to help disperse the medication and prevent leakage, but massaging should be avoided.
D. Aspiration is not necessary for subcutaneous injections. It is generally used for intramuscular injections to ensure the needle is not in a blood vessel, which is less of a concern for subcutaneous injections. The injection technique involves pinching the skin and injecting the medication into the subcutaneous tissue without aspirating.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. This range represents the normal serum magnesium level. It is important for maintaining neuromuscular function and other vital processes in the body.
A. This range is too low for normal serum magnesium levels. Magnesium levels below this range can indicate hypomagnesemia, which can lead to symptoms such as muscle cramps, tremors, and cardiac arrhythmias.
C. This range is too high for normal serum magnesium levels. Elevated magnesium levels (hypermagnesemia) can occur in conditions such as renal failure or excessive magnesium intake, leading to symptoms like weakness, decreased reflexes, and in severe cases, cardiac arrest.
D. While this range is broader and includes the correct normal range (1.3-2.1 mEq/L), it also includes values that are below and above normal. Values below 1.3 mEq/L can indicate hypomagnesemia, while values above 2.1 mEq/L can indicate hypermagnesemia.
Correct Answer is A
Explanation
A. A 5 mL syringe can hold up to 5 mL of fluid. It is suitable for administering 2 mL of medication, as it provides enough capacity with some additional space to ensure accurate measurement and prevent overfilling.
B. A 1 mL syringe is too small for administering a 2 mL injection. It would not accommodate the entire volume, and attempting to draw and administer 2 mL with a 1 mL syringe could result in spillage or inaccurate dosing.
C. A 10 mL syringe is larger than necessary for administering a 2 mL injection. While it can hold the required volume and more, it is bulkier and might be less convenient for administering smaller volumes like 2 mL.
D. A 3 mL syringe can also accommodate a 2 mL injection. However, a 5 mL syringe would provide a more appropriate capacity with a bit of extra space, which can be beneficial for accurate measurement and ease of administration.
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