A patient is receiving an IV of esmolol 2.5 grams in 250 mL of D5W (dextrose 5% in water) infusing at 200 micrograms/kilogram/minute. The patient weighs 110 lb. What rate (in mL/hr) should the nurse program into the IV pump to deliver this dose?

These statements are correct because they follow the guidelines for intradermal injections, which are used for skin testing, such as for allergies or tuberculosis. Intradermal injections are given into the dermis, which is the layer of skin below the epidermis.
The needle is inserted with the bevel of the needle upward at a 10- to 15-degree angle to ensure that the medication is delivered into the dermis and not into the subcutaneous tissue or the epidermis. The bevel is

the slanted part of the needle tip that creates a sharp point. Inserting the needle with the bevel upward also reduces tissue trauma and bleeding.
The inner arm or upper back are the preferred sites for intradermal injections because they have thin skin and minimal hair, which makes it easier to see and measure any reactions. The inner arm is usually used for adults, while the upper back is used for children.
The other statements are not correct because they do not apply to intradermal injections or they contain false information.

a. A depressed area around the injection sites indicates a positive reaction. This statement is false because a depressed area, also known as induration, indicates a negative reaction. A positive reaction is indicated by a raised area, also known as a wheal, that is larger than a certain size depending on the type of test.

b. After the insertion of the needle, a healthcare provider should aspirate for a blood return. This statement does not apply to intradermal injections because aspiration is not necessary for this type of injection. Aspiration is the process of pulling back on the plunger of the syringe to check for blood in the needle before injecting the medication. This is done to avoid injecting into a blood vessel, which can cause adverse effects or reduce the effectiveness of the medication. However, intradermal injections are given into very superficial layers of skin where there are no blood vessels, so aspiration is not required.

This answer is correct because BSA is the most accurate method for calculating the child's dose from the adult dose¹². BSA takes into account the child's weight and height, and reflects the physiological function and organ growth of the child beter than weight alone¹. BSA can be calculated using a nomogram or a formula based on the child's weight and height¹. The child's dose can then be calculated by multiplying the adult dose by the ratio of the child's BSA to the average adult BSA (1.73 m2)¹. For example:

Child dose by BSA = (mg/day) = Adult Dose in mg/day x BSA in m2 / 1.73

OR

Child dose by BSA = (mg/day) = Adult Dose in mg/m2 x BSA in m2

The other options are not correct because they are not accurate methods for calculating the child's dose from the adult dose. Actual body weight and ideal body weight may not account for individual variations in pharmacokinetics, pharmacodynamics, or clinical response. Actual body height is not a reliable indicator of drug dosage, as it does not reflect the body mass or organ function of the child.