The nurse is preparing to administer 40 mg of enoxaparin subcutaneously to a patient. Which of the following techniques should the nurse use?
The nurse should aspirate immediately prior to injecting the medication.
The nurse should gently massage the injection site immediately afterward.
The nurse should draw up the medication into a 1-mL syringe with a 32-gauge needle.
The nurse should inject the medication into the soft tissue of the patient’s abdomen.
The Correct Answer is D
Choice A rationale:
Aspiration prior to injection of enoxaparin is not recommended. Key reasons for this contraindication include:
Absence of Large Blood Vessels in Subcutaneous Tissue: Enoxaparin is administered subcutaneously, targeting the fatty tissue layer beneath the skin. This tissue generally lacks large blood vessels, significantly reducing the risk of accidental intravascular injection. Aspiration, traditionally intended to prevent such occurrences, becomes unnecessary in this context.
Potential for Hematoma Formation: The act of aspiration itself can create a vacuum within the subcutaneous tissue, leading to trauma and bleeding at the injection site. This can result in hematoma formation, causing discomfort and potential interference with medication absorption.
No Evidence of Benefit: Research studies have not demonstrated any clear advantages of aspiration when administering subcutaneous enoxaparin injections. In fact, some studies have suggested a potential increase in bruising and bleeding associated with aspiration.
Manufacturer Guidelines: Enoxaparin manufacturers explicitly advise against aspiration in their product instructions, aligning with current evidence-based practices.
Choice B rationale:
Massaging the injection site after administering enoxaparin is also not recommended.
Rationale for this contraindication:
Accelerated Absorption: Massaging can increase local blood flow, potentially accelerating the absorption of enoxaparin. This could lead to higher-than-intended drug levels in the bloodstream, increasing the risk of bleeding complications.
Discomfort and Hematoma Risk: Similar to aspiration, massage can create mechanical stress on the injection site, potentially causing bruising, discomfort, or hematoma formation.
Choice C rationale:
While a 1-mL syringe with a 32-gauge needle is a suitable option for subcutaneous injections, it's not the only correct choice. Considerations for syringe and needle selection:
Needle Length: The needle should be short enough to ensure subcutaneous administration, typically ranging from 5/8 to 1 inch in length.
Syringe Size: The syringe size should accommodate the volume of medication being administered, providing clear visibility of the dose.
Patient Comfort: Smaller-gauge needles (like 32-gauge) are often preferred for subcutaneous injections as they tend to cause less discomfort. However, other factors, such as medication viscosity and patient preferences, may influence needle selection.
Choice D rationale:
The abdomen is the preferred injection site for enoxaparin due to several reasons:
Abundant Subcutaneous Tissue: The abdomen generally has a thicker layer of subcutaneous tissue, providing ample space for medication absorption and reducing the risk of intramuscular injection.
Ease of Access: The abdomen is often easily accessible for self-injection or administration by a caregiver, promoting patient comfort and convenience.
Reduced Pain: Subcutaneous injections in the abdomen are typically less painful compared to other potential sites like the arms or thighs.
Additional considerations for enoxaparin administration:
Rotate Injection Sites: To prevent tissue damage and promote consistent absorption, it's crucial to rotate injection sites within the recommended areas (abdomen, thighs, upper buttocks).
Monitor for Adverse Effects: Observe for any signs of bleeding, bruising, or allergic reactions following enoxaparin administration.
Adhere to Storage Guidelines: Store enoxaparin at room temperature and protect it from light to ensure its efficacy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale for Choice A:
Mixing insulin detemir and insulin aspart in the same syringe is not recommended due to their differing physicochemical properties and potential for altered absorption and action profiles.
It's crucial to follow manufacturer guidelines, as mixing may lead to suboptimal glycemic control or unpredictable insulin activity.
Rationale for Choice B:
The order of mixing insulin detemir and insulin aspart, even if done incorrectly in the same syringe, would not significantly impact the overall contraindication of mixing them.
The primary concern remains the potential for altered pharmacodynamics and pharmacokinetics when these insulins are combined.
Rationale for Choice C:
Drawing up insulin aspart and insulin detemir in separate syringes is the correct procedure.
This approach ensures that each insulin maintains its intended action profile and absorption characteristics, leading to more predictable glycemic control.
It also aligns with best practices and guidelines for insulin administration.
Rationale for Choice D:
While drawing up insulin detemir first in a separate syringe is technically correct, it offers no specific advantage over drawing up insulin aspart first in a separate syringe.
The key principle is to avoid mixing the two insulins in the same syringe.
Correct Answer is C
Explanation
Choice A rationale:
The dorsal gluteal site (also known as the dorsogluteal site) was previously a common injection site, but it's now not recommended due to several significant risks:
Proximity to the sciatic nerve: The sciatic nerve is the largest nerve in the body, and it runs close to the dorsal gluteal site. Accidental injection into or near the nerve can cause severe pain, nerve damage, and potential paralysis.
Difficulty in locating landmarks: The landmarks for the dorsal gluteal site can be difficult to locate accurately, especially in obese patients or those with decreased muscle mass. This increases the risk of injecting into the wrong area.
Risk of injury to blood vessels: The dorsal gluteal site also has a higher risk of injury to blood vessels, as several large vessels run through the area.
Choice B rationale:
The deltoid muscle is located in the upper arm and is a common site for intramuscular injections, but it has limitations for larger volumes:
Small muscle size: The deltoid muscle is relatively small compared to other IM injection sites. It's generally recommended for smaller volumes of medication (up to 1 mL in adults).
Subcutaneous tissue: The deltoid muscle often has a layer of subcutaneous tissue (fat) that can hinder absorption of medication.
Choice C rationale:
The vastus lateralis muscle is the preferred site for intramuscular injections in adults for several reasons:
Large muscle size: It's a large, thick muscle that can accommodate larger volumes of medication (up to 5 mL in adults). Easy to locate landmarks: The landmarks for the vastus lateralis are easy to identify, even in obese patients.
Few major nerves or blood vessels: It has fewer major nerves or blood vessels in the area, reducing the risk of injury. Pain tolerance: It's generally considered to be a less painful injection site than the deltoid or dorsogluteal sites.
Choice D rationale:
The lateral piriformis muscle is not a recognized or recommended site for intramuscular injections. It's a deep muscle located in the buttocks, and injecting into it would be difficult and potentially dangerous due to its proximity to the sciatic nerve and other important structures.
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