Heparin 10,000 units subcutaneous every 12 hours is ordered for a patient after a stent placement.

The heparin is available in a 20,000 units per 1 mL concentration.

How many milliliters would the nurse administer with each dose? (ROUND TO TENTHS; LABEL CORRECTLY TO RECEIVE CREDIT)

Choice A rationale

The dorsogluteal site is generally not recommended for intramuscular injections of 2.5 mL, especially in children or patients with less developed muscle mass, due to the significant risk of sciatic nerve injury and variable muscle depth. Ventrogluteal is preferred for larger volumes.

Choice B rationale

The abdomen is primarily used for subcutaneous injections, not intramuscular injections due to its composition primarily of adipose tissue and lack of substantial muscle mass. Injecting 2.5 mL intramuscularly into the abdomen would be painful, ineffective, and potentially harmful.

Choice C rationale

The ventrogluteal site is a safe and preferred intramuscular injection site, capable of accommodating volumes up to 2.5 mL due to its thick gluteus medius and minimus muscles, far from major nerves and blood vessels, reducing the risk of complications.

Choice D rationale

The vastus lateralis muscle is a large, well-developed muscle, making it a suitable site for intramuscular injections of 2.5 mL, particularly in adults and children. Its accessibility and distance from major nerves make it a safe option for medication administration.

Choice E rationale

The deltoid muscle can accommodate intramuscular injections of up to 2 mL in adults, making it an acceptable site for 2.5 mL if the muscle mass is adequately developed. However, care must be taken to avoid the radial nerve and ensure proper needle length.

Choice A rationale

Avoiding palpation of tender areas completely would be an incomplete assessment. While direct, forceful palpation of an acutely tender area should be approached cautiously, it is essential to gently assess the area's boundaries, consistency, and the presence of rebound tenderness or guarding to gather crucial diagnostic information.

Choice B rationale

Examining the tender area first in an abdominal assessment can cause significant pain and muscle guarding, making it difficult to assess other quadrants effectively and potentially skewing the assessment findings. This approach can also reduce patient cooperation for the remainder of the examination.

Choice C rationale

Auscultation for bowel sounds typically precedes palpation in an abdominal assessment because palpation can alter bowel motility and therefore the character of bowel sounds. While palpating the tender area last is correct, performing auscultation after palpation would introduce an artifact.

Choice D rationale

Examining the tender area last is the correct technique during an abdominal assessment. This approach minimizes patient discomfort, allows for a more thorough and accurate assessment of the non-tender areas first, and helps to establish rapport before eliciting potential pain, thereby ensuring a more reliable and complete examination.