Amoxicillin 500 mg is ordered for a patient with a sinus infection. Amoxicillin oral suspension 200 mg per 5 mL is available.
How many mL should the nurse administer?

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 instruction should be given to the patient for the effective management of asthma because the patient is taking an overdose of ipratropium, which may cause serious side effects such as dry mouth, blurred vision, urinary retention, or increased heart rate. The recommended dosage of ipratropium for adults with acute asthma is 0.5 mg (500 mcg) every 20 minutes for three doses, followed by 0.5 mg every two to four hours as needed³. The patient's prescribed dose is 5 mg/kg, which means 300 mg/day for a 60 kg patient. This is 10 times the maximum daily dose of 2 mg (2000 mcg) for ipratropium⁴. Therefore, the patient should halve the dose of medication to 150 mg/day, which is still higher than the usual dosage, but within the range that can be given under medical supervision.

The other options are not appropriate instructions because:

a) Continuing the same dose of medication may worsen the patient's condition and increase the risk of adverse reactions.

b) Changing to alternative medication may not be necessary or effective, as ipratropium is a commonly used bronchodilator for asthma that works by relaxing the airway muscles and improving airflow⁵. The patient may benefit from adjusting the dose or adding other medications, such as corticosteroids or beta-agonists, depending on the severity and frequency of symptoms.

c) Doubling the dose of medication may be dangerous and potentially fatal, as it may cause severe anticholinergic effects, such as dry mouth, blurred vision, urinary retention, increased heart rate, confusion, or coma.