The physician orders Ticar 800mg IM qoh.

The medication is supplied in 1g/2.5 mL. How many milliliters will the nurse administer? (SHADE SYRINGE #1 TO CORRECT DOSE & LABEL CORRECTLY TO RECEIVE CREDIT)

Choice A rationale

Determining areas of tenderness is typically done through palpation, which should follow auscultation to avoid altering bowel sounds. Performing palpation first could elicit guarding or muscle rigidity, making subsequent auscultation less accurate and potentially increasing patient discomfort.

Choice B rationale

Auscultation precedes percussion and palpation of the abdomen to ensure that bowel sounds are not artificially stimulated or inhibited. Mechanical manipulation of the abdomen through percussion and palpation can alter the frequency and character of bowel sounds, leading to inaccurate assessment of intestinal motility.

Choice C rationale

While patient comfort is important, the primary reason for the sequence of abdominal assessment is scientific accuracy. Manipulating the abdomen prior to auscultation can stimulate peristalsis, creating false-positive bowel sounds or increasing existing ones, thus obscuring the true baseline activity.

Choice D rationale

Distortion of vascular sounds like bruits and hums is less likely to be significantly affected by percussion and palpation compared to bowel sounds. Vascular sounds originate from blood flow dynamics, which are not as readily influenced by external mechanical manipulation as the peristaltic activity of the intestines.

Choice A rationale

The ventrogluteal muscle is a preferred site for Z-track injections due to its thick musculature, which minimizes the risk of hitting nerves or blood vessels. Its anatomical location provides a deep, safe space for medication deposition, allowing for effective sealing of the drug within the muscle tissue, preventing leakage and irritation to subcutaneous tissues.

Choice B rationale

The deltoid muscle is generally not preferred for Z-track injections because its smaller muscle mass and proximity to the radial nerve and brachial artery increase the risk of neurovascular injury. While used for some intramuscular injections, the Z-track technique benefits from larger muscle groups to effectively seal the medication.

Choice C rationale

The dorsogluteal muscle, though historically used, is considered less ideal than the ventrogluteal site for Z-track injections due to a higher risk of sciatic nerve injury and penetration of major blood vessels. However, its large muscle mass can still accommodate Z-track injections when alternative sites are contraindicated, if proper landmarks are meticulously observed.

Choice D rationale

The abdomen, 2 inches from the umbilicus, is primarily used for subcutaneous injections, not intramuscular Z-track injections. This area lacks the deep muscle tissue necessary to effectively deposit and seal medication using the Z-track technique, and attempting intramuscular injection here poses a high risk of hitting vital organs.

Choice E rationale

The posterior thigh, specifically the rectus femoris or vastus lateralis, can be used for intramuscular injections, but it is not a primary preferred site for the Z-track technique in adults due to varying muscle thickness and increased potential for discomfort. The ventrogluteal site generally offers a larger and safer muscle mass.