The physician orders Epogen 4500 units subcutaneous for red blood cell production.

The medication is supplied in 4,000 units/mL. How many milliliters will the nurse administer? Round to tenths.

Choice A rationale

The abdomen, specifically 2 inches from the umbilicus, is a common site for subcutaneous injections due to the presence of ample adipose tissue, which allows for slower absorption of medications like insulin or heparin. Intradermal injections require a site with a thin epidermis and minimal subcutaneous tissue to ensure the medication remains within the dermal layer, making the abdomen unsuitable.

Choice B rationale

The anterior thigh is a common site for intramuscular injections, particularly in infants, due to the large muscle mass (vastus lateralis). While it can be used for subcutaneous injections, its muscularity and varying skin thickness make it less ideal for the precise shallow angle required for an intradermal injection, where the goal is to deposit the medication into the dermis.

Choice C rationale

The posterior upper arm, specifically the triceps area, is frequently utilized for subcutaneous injections, such as insulin or certain vaccines, because it offers sufficient subcutaneous tissue. However, similar to the anterior thigh, its anatomical characteristics with thicker skin and subcutaneous fat layers make it less optimal for the very superficial intradermal injection technique.

Choice D rationale

The upper chest, particularly below the clavicle and above the breasts, is an appropriate site for intradermal injections. This area, along with the inner forearm and upper back, has a thin epidermis and less subcutaneous tissue, which facilitates the proper placement of the medication within the dermis, allowing for the formation of a visible wheal, a key indicator of a successful intradermal injection.

Choice A rationale

Placing the patch in the same location repeatedly can lead to skin irritation, reduced absorption due to stratum corneum thickening, and localized adverse reactions. Rotation of application sites allows the skin to recover, maintains optimal drug absorption, and prevents cumulative dermal irritation.

Choice B rationale

Transdermal patches often contain significant amounts of medication, including controlled substances or potent drugs. Discarding them in the trash can poses risks of accidental exposure to others, environmental contamination, and diversion. Proper disposal protocols, such as flushing or returning to pharmacy, are crucial.

Choice C rationale

While transdermal patches are designed for systemic absorption, specific sites are recommended to optimize efficacy and minimize adverse effects. Areas with less hair, intact skin, and good circulation are preferred. Improper placement can lead to erratic absorption or local irritation, reducing therapeutic benefit.

Choice D rationale

The nurse should always wear gloves when handling transdermal patches to prevent direct skin contact with the medication. Many transdermal drugs can be absorbed through the nurse's skin, leading to unintended pharmacological effects or sensitization. Gloves provide a crucial barrier against dermal absorption.