The nurse is preparing a syringe using medication from a vial. Which guideline is recommended for this procedure?

Insert needle through side of stopper and draw medication into the barrel.

Pull back on the syringe's plunger and fill the barrel completely with the medication.

Draw an amount of air into the syringe equal to medication needed.

Remove the cover from the vial and clean with soapy water.

Answer and Explanation

The Correct Answer is C

A. Insert needle through side of stopper and draw medication into the barrel: The needle must be inserted straight through the center of the rubber stopper, not the side, to ensure the seal integrity is maintained and prevent coring (cutting out a piece of the stopper).

B. Pull back on the syringe's plunger and fill the barrel completely with the medication: Pulling back the plunger and filling the barrel completely (i.e., administering 3 mL in a 3-mL syringe) is not always correct; the volume should only match the dose ordered by the physician.

C. Draw an amount of air into the syringe equal to medication needed: To ensure easy withdrawal of the liquid medication and to prevent a vacuum from forming inside the vial (which makes withdrawal difficult), an equal volume of air must be injected into the vial first.

Remove the cover from the vial and clean with soapy water: The rubber stopper must be cleaned with an antiseptic swab (e.g., alcohol swab), not soapy water, before the needle is inserted. The protective cap is usually removed and the swab applied.

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Correct Answer is C

Explanation

A. 1-mL tuberculin syringe with 1-inch bevel:Tuberculin syringes are used for small-volume Intradermal or Subcutaneous injections. They are not suitable for the viscosity or depth required for an IM corticosteroid injection.

B. 1-to 2-mL syringe with 1/2-to 1-inch needle:While a 1-inch needle canbe used for the deltoid in some adults, a 1/2-inch needle is too short to reach deep muscle tissue in an average adult, risking subcutaneous deposition (which can cause tissue damage with corticosteroids).

C. 2-to 3-ml syringe with 1-to 1 1/2-inch needle:This is the standard equipment for an adult IM injection. A 3-mL syringe accommodates the medication volume, and a 1 to 1.5-inch needle ensures the medication passes through subcutaneous fat and reaches the deep muscle tissue (Ventrogluteal or Vastus Lateralis).

D. 2-to 3-ml syringe with 1- to 2-inch needle:While the syringe size is correct, a 2-inch needle is typically reserved for patients with obesity who have a larger layer of adipose tissue to penetrate. For an average adult, this may be too long and could strike bone.

A. 2.0 mg B. 2 mg C. 0.2 mg D. 0.20 mg

Correct Answer is C

Explanation

A.2.0 mg: This violates the "Trailing Zero" rule. A zero should never be placed after a decimal point for a whole number. If the decimal is missed by the reader, 2.0 mg could be easily misread as 20 mg, leading to a massive overdose.
B.2 mg: This is a mathematical error. 2 mg is a whole number, whereas the prescription is for "two tenths" (0.2) of a milligram. Administering this would result in a tenfold overdose.
C.0.2 mg: This follows the "Leading Zero" rule mandated by the Institute for Safe Medication Practices (ISMP). When a dose is less than a whole number, a zero must be placed before the decimal point. This ensures that if the decimal point is faint or overlooked, the reader will not mistake .2 mg for 2 mg.
D.0.20 mg: While mathematically equivalent to 0.2, this violates the "Trailing Zero" rule. The final zero is unnecessary and increases the risk of the number being misread as 20 or 2 if the decimal is not clearly seen.

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