Which factor contributes to the formation of a pressure injury when a patient’s body slides downward to the foot of the bed?

Choice A rationale:

Intravenous (IV) administration delivers medication directly into the bloodstream. This route is not appropriate for insulin because it would result in a rapid and potentially dangerous drop in blood glucose levels. Insulin needs to be absorbed more slowly to mimic the natural release of insulin from the pancreas.

IV administration also requires sterile technique and specialized equipment, making it more complex and time-consuming than subcutaneous injection.

Additionally, there is a higher risk of infection and other complications with IV administration.

Choice B rationale:

The vastus lateralis is a muscle in the thigh that is commonly used for intramuscular (IM) injections. However, IM injections are not typically used for insulin administration because they can be more painful and have a slower absorption rate than subcutaneous injections.

IM injections also carry a higher risk of hitting a blood vessel, which could lead to erratic absorption of insulin.

Choice D rationale:

The deltoid is a muscle in the upper arm that can be used for subcutaneous injections. However, the abdomen is generally the preferred site for insulin injection because it has a greater amount of subcutaneous fat, which helps to slow the absorption of insulin and provide a more consistent effect.

The abdomen is also a more convenient site for self-injection, as it is easily accessible.

Choice C rationale:

The fatty tissue of the abdomen is the ideal site for subcutaneous insulin injection because it provides slow and consistent absorption of insulin.

The abdomen has a rich blood supply, which helps to distribute the insulin throughout the body.

The subcutaneous tissue in the abdomen is relatively thin, which makes it easy to inject insulin without causing pain or discomfort.

The abdomen is also a large area, which allows for multiple injection sites to be used and rotated to prevent lipohypertrophy (thickening of the subcutaneous tissue).

Choice A rationale:

Incorrect. Patients who develop tolerance to a medication do not typically maintain a stable dose over time. Instead, they often require increasing doses to achieve the same effect.

Physiological adaptation: The body adapts to the presence of the medication, leading to a decreased response over time. This adaptation can occur at various levels, including receptor downregulation, changes in enzyme activity, or alterations in neurotransmitter release.

Individual variability: The rate and extent of tolerance development vary significantly among individuals, influenced by factors such as genetics, age, overall health, and medication type.

Choice B rationale:

Incorrect. Impaired liver or kidney function can affect drug metabolism and elimination, but this is not the primary mechanism of tolerance.

Metabolic impairment: Liver or kidney dysfunction can lead to drug accumulation in the body, potentially increasing the risk of side effects or toxicity. However, this does not necessarily cause tolerance, which is a specific phenomenon of decreased responsiveness to the medication's effects.

Choice C rationale:

Correct. This statement accurately describes the hallmark characteristic of tolerance.

Dose escalation: As tolerance develops, patients often require higher doses of the medication to achieve the same therapeutic effect. This can lead to a cycle of increasing doses and potential risks of adverse effects.

Clinical implications: Tolerance is a significant consideration in medication management, as it can affect treatment efficacy, adherence, and the risk of side effects.

Choice D rationale:

Incorrect. Tolerance can develop even when patients adhere strictly to their prescribed medication regimen. It is a physiological phenomenon that is not solely dependent on patient behavior.

Adherence vs. tolerance: While non-adherence can contribute to treatment failure, it is not the underlying cause of tolerance.