The nurse is teaching an overweight patient to administer subcutaneous heparin. Which statement by the patient indicates understanding of the teaching?
"I should insert the needle and inject the medication without aspirating for blood."
"I should put firm pressure on the injection site to decrease the risk for bleeding."
"I will insert the needle at a 10-degree angle when injecting."
"The subcutaneous route is used because absorption is faster this way."
The Correct Answer is A
A. When administering subcutaneous heparin, aspiration should be avoided because it can cause tissue damage and increase the risk of hematoma formation. This statement correctly reflects safe administration technique.
B. Firm pressure on the injection site is not recommended after heparin administration because it can increase the risk of bruising and bleeding. Instead, gentle pressure should be applied if necessary.
C. Subcutaneous injections should be given at a 45- to 90-degree angle, depending on the patient’s body mass. A 10-degree angle is too shallow and may result in improper medication delivery.
D. The subcutaneous route does not provide faster absorption than other routes such as intravenous or intramuscular. Instead, it allows for slow, steady absorption, which is desirable for anticoagulants like heparin.
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Related Questions
Correct Answer is D
Explanation
a) While knowing if the patient takes generic medications is useful, it is not the priority. Generic and brand-name drugs generally have the same active ingredients and effects.
b) Orphan drugs are used to treat rare diseases, but this is not a primary concern for most patients and does not directly impact medication safety in routine assessments.
c) Asking about medication safety during pregnancy is important if the patient is pregnant or could become pregnant, but it is not the primary concern for all patients.
d) Over-the-counter (OTC) medications can interact with prescribed medications, potentially leading to adverse effects or reduced efficacy. It is crucial to assess OTC use to ensure there are no dangerous drug interactions.
Correct Answer is D
Explanation
A. Deficient knowledge may be a concern, but the primary focus here is on the safety risk associated with the side effects of the medication, particularly dizziness and orthostatic hypotension, which increase the risk of falls or injury.
B. Ineffective health maintenance is not specific to the medication side effects and does not directly address the patient's safety risk due to the medication.
C. Readiness for enhanced knowledge is more appropriate when the patient is already familiar with their condition and medication and is ready to learn more. This is not the case here, as the focus is on preventing harm from side effects.
D. Risk for injury is the most appropriate nursing diagnosis. Dizziness and orthostatic hypotension increase the risk of falls, which can lead to injury, making this the most relevant concern in this scenario.
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