You can be sure you have administered the intradermal injection properly if which occurs?
There is no pain at the site.
There is immediate blood return at the site.
The skin remains flat and turns red at the injection site.
A bleb or wheal occurs immediately.
The Correct Answer is D
Choice A rationale
Absence of pain at the site of an intradermal injection does not confirm proper administration. While minimizing pain is a goal, the primary indicator of correct intradermal placement is the formation of a bleb, which signifies the medication has been correctly deposited within the dermal layer, not subcutaneously.
Choice B rationale
Immediate blood return at the site of an intradermal injection indicates improper technique, specifically penetration into a blood vessel. Intradermal injections are administered into the avascular dermal layer; therefore, aspiration should yield no blood, and blood return necessitates withdrawing and restarting the injection at a new site.
Choice C rationale
Skin remaining flat and turning red at the injection site is not indicative of proper intradermal injection. Redness may occur due to irritation, but a flat appearance suggests the medication was either injected too deeply into the subcutaneous tissue or insufficient volume was administered into the dermal layer to form a bleb.
Choice D rationale
The immediate formation of a bleb or wheal, resembling a small blister, is the definitive sign of a correctly administered intradermal injection. This occurs because the medication is deposited precisely into the superficial dermal layer of the skin, causing a localized elevation as the fluid displaces tissue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
Choice A rationale
The dorsogluteal site is generally not recommended for intramuscular injections of 2.5 mL, especially in children or patients with less developed muscle mass, due to the significant risk of sciatic nerve injury and variable muscle depth. Ventrogluteal is preferred for larger volumes.
Choice B rationale
The abdomen is primarily used for subcutaneous injections, not intramuscular injections due to its composition primarily of adipose tissue and lack of substantial muscle mass. Injecting 2.5 mL intramuscularly into the abdomen would be painful, ineffective, and potentially harmful.
Choice C rationale
The ventrogluteal site is a safe and preferred intramuscular injection site, capable of accommodating volumes up to 2.5 mL due to its thick gluteus medius and minimus muscles, far from major nerves and blood vessels, reducing the risk of complications.
Choice D rationale
The vastus lateralis muscle is a large, well-developed muscle, making it a suitable site for intramuscular injections of 2.5 mL, particularly in adults and children. Its accessibility and distance from major nerves make it a safe option for medication administration.
Choice E rationale
The deltoid muscle can accommodate intramuscular injections of up to 2 mL in adults, making it an acceptable site for 2.5 mL if the muscle mass is adequately developed. However, care must be taken to avoid the radial nerve and ensure proper needle length.
Correct Answer is ["0.004"]
Explanation
Step 1 is: Convert mcg to mg. There are 1000 mcg in 1 mg.
Step 2 is: 4 mcg ÷ (1000 mcg/1 mg) = 0.004 mg. Answer: 0.004 mg.
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