The nurse is preparing a subcutaneous (SC) injection medication for an average-sized client.
The needle should be inserted at Select. degrees, and the skin should be Select.

Choice A rationale

Frostbite causes localized tissue damage due to ice crystal formation and cellular dehydration, leading to impaired circulation. While frostbite can affect capillary refill, a 5-second refill time in the absence of cold exposure or other correlating symptoms makes frostbite a less likely primary consideration and requires broader assessment.

Choice B rationale

Venous insufficiency involves impaired blood return to the heart, leading to venous stasis and edema. Capillary refill primarily assesses arterial perfusion and microcirculatory integrity, not venous outflow. Therefore, venous insufficiency would not typically manifest as a prolonged capillary refill time as a primary symptom.

Choice C rationale

Normal capillary refill time in adults is typically less than 2 seconds. A 5-second capillary refill time indicates impaired peripheral perfusion, suggesting inadequate blood flow to the capillaries. This delay warrants further investigation to identify underlying causes such as dehydration, hypovolemia, or peripheral vascular compromise.

Choice D rationale

Normal capillary refill time is typically less than 2 seconds. A 5-second refill time is significantly prolonged and indicates compromised peripheral circulation. Considering this normal would lead to a missed opportunity to identify and address a potentially serious underlying physiological issue affecting tissue perfusion.

Choice A rationale

An intradermal injection is administered into the dermis, the layer of skin directly beneath the epidermis. A 15-degree angle ensures the needle enters superficially, creating a small wheal as the medication is deposited. This shallow angle minimizes penetration into subcutaneous tissue, which is crucial for proper antigen-antibody reactions in allergy testing or tuberculosis screening.

Choice B rationale

A 90-degree angle is used for intramuscular injections, where the medication is delivered deep into muscle tissue. This angle allows for rapid absorption due to the rich vascular supply of muscle, but it would cause excessive penetration and potential systemic absorption if used for an intradermal injection, negating its diagnostic purpose.

Choice C rationale

A 45-degree angle is typically used for subcutaneous injections, delivering medication into the adipose tissue layer beneath the dermis. This angle is too deep for an intradermal injection and would result in the medication being absorbed systemically rather than remaining in the dermal layer for localized diagnostic reactions.

Choice D rationale

A 30-degree angle is also too steep for an intradermal injection. While less deep than a 45-degree angle, it still risks penetrating beyond the dermis into the subcutaneous tissue. The goal of an intradermal injection is to deposit the substance within the highly specific dermal layer to elicit a localized, measurable response.