Which of these syringes and needles should a nurse use for an intradermal injection?

Choice A rationale

Asking the client to stick out their tongue and move it from side to side, then up and down, directly assesses the function of the hypoglossal nerve (cranial nerve XII). This nerve innervates the intrinsic and extrinsic muscles of the tongue, controlling its movement, which is essential for speech and swallowing, thereby evaluating its motor integrity.

Choice B rationale

Asking the client to stick out their tongue primarily assesses general tongue protrusion, but does not provide as comprehensive an assessment of hypoglossal nerve function as evaluating its full range of motion. Unilateral weakness or deviation, which is indicative of nerve damage, is better observed with side-to-side and up-and-down movements.

Choice C rationale

Asking the client to cover one eye and read a note card assesses visual acuity and the function of the optic nerve (cranial nerve II). This technique evaluates the eye's ability to perceive details and is unrelated to the motor function of the tongue or the hypoglossal nerve.

Choice D rationale

Having the patient smile, frown, and puff their cheeks primarily assesses the facial nerve (cranial nerve VII). This nerve controls the muscles of facial expression, including those involved in smiling, frowning, and puffing out the cheeks, and is distinct from the hypoglossal nerve's role in tongue movement.

Choice A rationale

Administering nitroglycerin on an as-needed basis for sudden, crushing chest pain is inappropriate because the immediate nature of the pain requires rapid intervention. Myocardial ischemia, often causing such pain, necessitates swift vasodilation to improve coronary blood flow and oxygen supply, preventing irreversible cardiac muscle damage. Delay can exacerbate ischemia.

Choice B rationale

Administering nitroglycerin on a prescribed schedule is typically reserved for prophylactic use in conditions like stable angina to prevent episodes, not for acute, sudden onset chest pain. This type of pain indicates an acute event, potentially myocardial infarction, demanding immediate action to mitigate cardiac damage through rapid vasodilation.

Choice C rationale

Administering medication at the earliest convenience is not appropriate for a STAT order in a patient experiencing sudden, crushing chest pain. "STAT" signifies an urgent need for the medication, indicating a life-threatening or rapidly evolving condition requiring immediate pharmacological intervention to avert significant physiological compromise.

Choice D rationale

Administering nitroglycerin immediately is crucial for sudden, crushing chest pain as it suggests acute myocardial ischemia or infarction. Nitroglycerin causes vasodilation, reducing preload and afterload, which decreases myocardial oxygen demand and improves coronary blood flow, thereby limiting cardiac damage and alleviating symptoms rapidly.