During an assessment of a 20-year-old African-American's external auditory meatus, the nurse notes the presence of cerumen.

What is the significance of this finding?

Choice A rationale

The ventrogluteal muscle is a preferred site for Z-track injections due to its thick musculature, which minimizes the risk of hitting nerves or blood vessels. Its anatomical location provides a deep, safe space for medication deposition, allowing for effective sealing of the drug within the muscle tissue, preventing leakage and irritation to subcutaneous tissues.

Choice B rationale

The deltoid muscle is generally not preferred for Z-track injections because its smaller muscle mass and proximity to the radial nerve and brachial artery increase the risk of neurovascular injury. While used for some intramuscular injections, the Z-track technique benefits from larger muscle groups to effectively seal the medication.

Choice C rationale

The dorsogluteal muscle, though historically used, is considered less ideal than the ventrogluteal site for Z-track injections due to a higher risk of sciatic nerve injury and penetration of major blood vessels. However, its large muscle mass can still accommodate Z-track injections when alternative sites are contraindicated, if proper landmarks are meticulously observed.

Choice D rationale

The abdomen, 2 inches from the umbilicus, is primarily used for subcutaneous injections, not intramuscular Z-track injections. This area lacks the deep muscle tissue necessary to effectively deposit and seal medication using the Z-track technique, and attempting intramuscular injection here poses a high risk of hitting vital organs.

Choice E rationale

The posterior thigh, specifically the rectus femoris or vastus lateralis, can be used for intramuscular injections, but it is not a primary preferred site for the Z-track technique in adults due to varying muscle thickness and increased potential for discomfort. The ventrogluteal site generally offers a larger and safer muscle mass.

Choice A rationale

Documenting the error and notifying the supervisor are necessary steps, but they are not the most immediate or comprehensive actions. The priority in a medication error is patient safety, which requires immediate medical assessment and intervention. This step follows after direct patient care and notification of the physician.

Choice B rationale

Administering the original drug and observing for adverse reactions addresses part of the problem, but it does not prioritize immediate medical consultation regarding the mistakenly administered drug. The focus should be on the potential effects of the incorrect medication and timely intervention to mitigate harm.

Choice C rationale

The most appropriate and immediate action is to call the physician to inform them of the medication error. This allows the physician to assess the potential harm to the patient based on the specific drug, dosage, and patient's condition, and to order appropriate interventions. An incident report is crucial for organizational learning and quality improvement.

Choice D rationale

Deciding not to act based on a quick check of allergies or contraindications is highly negligent and unsafe. Even if there are no apparent immediate contraindications, any medication error carries inherent risks and requires a thorough medical evaluation by the physician. This approach prioritizes patient safety over documentation and investigation.