What syringe and needle would the nurse select to administer Mr. Robertson's insulin?

A. 90 degrees: Intramuscular injections require the needle to be inserted at a 90-degree angle to the skin to ensure the medication reaches the muscle tissue. This angle maximizes absorption and minimizes the risk of subcutaneous deposition, which can reduce efficacy or cause irritation.

B. 45 degrees: A 45-degree angle is used for subcutaneous injections, not IM injections. Administering an IM medication at this angle could result in the drug being deposited into subcutaneous tissue, slowing absorption and potentially causing local tissue irritation.

C. 60 degrees: There is no standard IM injection technique that uses a 60-degree angle. Using this angle could result in improper drug delivery and inconsistent absorption, making it unsafe and ineffective.

D. 30 degrees: A 30-degree angle is typically used for intradermal injections, such as tuberculin testing. Using this angle for IM injections would fail to reach the muscle, compromising medication effectiveness.

A. Report the discrepancy immediately after preparing the medication: Once a discrepancy in a controlled substance count is identified, the nurse should not continue handling or preparing the medication. Proceeding with preparation before resolving the discrepancy may further complicate accountability and chain-of-custody documentation.

B. Notify the Doctor and the Pharmacist immediately: Although pharmacy may eventually be involved in reconciliation, the first step is not to notify the physician. The appropriate immediate action is to follow institutional policy by notifying the charge nurse or supervisor responsible for controlled substance oversight rather than the prescribing provider.

C. Stop preparing the medication and notify the appropriate person immediately: A narcotic count discrepancy requires immediate action before any further medication handling occurs. Stopping preparation preserves the integrity of the count, prevents additional documentation errors, and initiates formal investigation per controlled substance regulations and facility policy.

D. Continue to pour as the count only needs to be correct at the end of the shift: Controlled substance counts must be accurate at all times, not just at shift change. Continuing to administer medication when a discrepancy exists violates legal standards, increases diversion risk, and places the nurse’s license at risk.