The preferred location for Mrs. Westmore's IM injection would be which of the following sites?

A. 90 degrees: The recommended angle for subcutaneous injection using an insulin pen is typically 90 degrees, especially with short needles (4–8 mm). This angle ensures the medication is delivered into the subcutaneous tissue rather than intradermally or intramuscularly, which could alter absorption and efficacy.

B. 45 degrees: A 45-degree angle may be used in patients with very little subcutaneous tissue or when using longer needles to avoid intramuscular injection. However, with most insulin pen needles today, 90 degrees is standard practice.

C. It doesn’t matter: The injection angle is critical for ensuring proper subcutaneous delivery. Administering at an incorrect angle could result in intramuscular injection, faster absorption, or tissue damage, so this is unsafe.

D. 30 degrees: Injecting at 30 degrees is generally reserved for intradermal injections, such as tuberculosis testing, and is not appropriate for insulin pen administration. Using this angle could result in improper dosing and reduced effectiveness.

A. Report the omission to the Doctor: While the provider may need to be informed if allergies are unknown or affect treatment, reporting alone does not fulfill the nurse’s responsibility to ensure accurate and complete documentation. Nurses are responsible for actively verifying and documenting allergies on the MAR.

B. Complete this section of the MAR: The nurse must obtain accurate allergy information directly from the patient and document it on the MAR. This ensures safe medication administration, prevents allergic reactions, and is a legal requirement for nursing. Verification should include drug, food, and environmental allergies with the nature of the reaction.

C. Have a colleague verify Mr. Robertson's allergies: Colleague verification is not sufficient unless the nurse has first collected accurate allergy information. Peer confirmation does not replace the nurse’s duty to personally assess and document the patient’s allergies.

D. Notify pharmacy that the MAR is incorrect and hold all medications: While pharmacy should be aware of incomplete or inaccurate MARs, holding all medications unnecessarily could harm the patient. The priority is to complete the allergy section promptly to continue safe administration rather than indiscriminately withholding treatment.