A nurse is reviewing a client's medical history before administering a new prescription for atropine. Which of the following client conditions is contraindicated?

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.

A. “Take a tablet every 10 minutes until the pain subsides.”: This is not correct. Nitroglycerin tablets are typically taken at the first sign of an angina attack. If the pain is not relieved within 5 minutes, a second tablet may be taken. If the pain still persists after another 5 minutes, a third tablet may be taken. However, if the pain continues after a total of 3 tablets in 15 minutes, emergency medical help should be sought.

B. “Place the tablet under the tongue until dissolved.”: This is the correct answer. Nitroglycerin sublingual tablets should be placed under the tongue and allowed to dissolve. This allows for rapid absorption of the medication into the bloodstream through the mucous membranes of the mouth.

C. “Store the tablets in a refrigerator in a plastic container.”: This is not correct. Nitroglycerin tablets should be stored at room temperature, away from light and moisture. They should not be stored in a refrigerator or a plastic container as this can cause the tablets to lose their effectiveness.

D. “Call 911 if pain persists 30 minutes after taking one tablet.”: This is not correct. If chest pain is not relieved within 5 minutes after taking a nitroglycerin tablet, a second tablet should be taken. If the pain still persists after another 5 minutes, a third tablet may be taken. However, if the pain continues after a total of 3 tablets in 15 minutes, emergency medical help should be sought. Waiting 30 minutes could delay necessary medical treatment.