Parenteral Medication Administration
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NCLEX-PN › Parenteral Medication Administration
A 63-year-old client with COPD is prescribed hydromorphone 0.2 mg IV push for severe post-operative pain. After administration, the client becomes difficult to arouse; RR 8/min, SpO2 86% on room air, BP 98/60. Which finding should be REPORTED immediately after medication administration?
Client reports mild itching without rash
RR 8/min with decreased level of consciousness
Pain decreased from 9/10 to 3/10
Client requests repositioning for comfort
Explanation
This question tests knowledge of parenteral medication administration and clinical judgment in opioid side effects. The key assessment finding after administration is RR 8/min with decreased consciousness, indicating overdose. Reporting the low RR with LOC change immediately is critical as it requires intervention like naloxone, aligning with safe practice. Pain reduction is expected; mild itching or repositioning requests are minor. The decision-making principle is rapid recognition of respiratory depression. Safety guidelines include continuous monitoring post-opioid. A transferable strategy is to have emergency protocols accessible for opioid-related events.
A 66-year-old client is receiving gentamicin IV for a post-operative infection. Latest labs: BUN 38 mg/dL, creatinine 2.1 mg/dL (elevated from baseline 1.0); urine output 20 mL/hr. Which finding should be REPORTED immediately after medication administration?
Temperature decreased from 101.2°F to 100.4°F (38.4°C to 38°C)
IV site is intact with no redness
Client reports mild nausea after breakfast
Creatinine 2.1 mg/dL with decreased urine output
Explanation
This question tests knowledge of parenteral medication administration and clinical judgment in aminoglycoside monitoring. The key assessment finding after administration is elevated creatinine with low urine output, signaling nephrotoxicity. Reporting the creatinine 2.1 mg/dL with decreased output immediately is critical as gentamicin can cause renal damage, aligning with safe practice. Mild nausea or temperature decrease is less urgent; intact IV site is positive but not the issue. The decision-making principle is to monitor renal function serially. Safety guidelines include holding for rising creatinine. A transferable strategy is to trend labs and output during ototoxic/nephrotoxic therapies.
The practical nurse is preparing to administer a 2 mL intramuscular (IM) injection of an antibiotic to an adult client. Which site is most appropriate for this injection?
Deltoid muscle
Dorsogluteal muscle
Vastus lateralis muscle
Ventrogluteal muscle
Explanation
The ventrogluteal site is the preferred and safest site for IM injections in adults, especially for volumes greater than 1 mL. It is a large muscle, free of major nerves and blood vessels. The deltoid muscle is used for smaller volumes (typically 1 mL or less). The dorsogluteal site is no longer recommended due to the risk of sciatic nerve injury. The vastus lateralis is a primary site for infants and toddlers.
The nurse is administering a subcutaneous injection of heparin. Which action by the nurse is correct?
Injecting into the abdominal tissue 2 inches from the umbilicus.
Massaging the site after the injection.
Using a 1.5-inch needle for the injection.
Aspirating for blood return before injecting.
Explanation
Heparin should be administered subcutaneously into the abdomen, at least 2 inches away from the umbilicus, to ensure proper absorption and avoid large blood vessels. Massaging the site can cause bruising and is contraindicated. Aspirating is not necessary for subcutaneous heparin and can increase tissue damage. A 1.5-inch needle is too long for a subcutaneous injection and would likely enter the muscle.
The nurse is using the Z-track method to administer an intramuscular injection of iron dextran. What is the primary purpose of this technique?
To ensure the medication is absorbed more rapidly.
To reduce the risk of injecting into a blood vessel.
To decrease the pain of the injection.
To prevent medication from leaking into subcutaneous tissue.
Explanation
The Z-track method involves pulling the skin and subcutaneous tissue to the side before injection, then releasing it after the needle is withdrawn. This creates a zigzag path that seals the medication deep within the muscle, preventing it from leaking back into the subcutaneous tissue and skin, which is especially important for irritating medications like iron.
The nurse is administering a tuberculin skin test. Which action demonstrates the correct technique for an intradermal injection?
Inserting the needle at a 45-degree angle.
Massaging the site after injecting the medication.
Inserting the needle with the bevel facing up.
Administering the injection into the subcutaneous tissue.
Explanation
For an intradermal injection, the needle should be inserted at a 5 to 15-degree angle with the bevel facing up. This ensures the medication is injected into the dermis, forming a small, visible wheal or bleb. A 45-degree angle is for subcutaneous injections. Massaging the site can disperse the medication and interfere with test results.
Which action should the nurse take FIRST?
Slow the IV infusion rate.
Stop the infusion and remove the catheter.
Notify the registered nurse (RN).
Elevate the affected extremity.
Explanation
The client's signs and symptoms (pain, pallor, coolness, swelling) are classic indicators of IV infiltration, where the IV fluid is leaking into the surrounding tissue. The first and most important action is to stop the infusion immediately to prevent further fluid from entering the tissue and causing more damage. After stopping the infusion, the nurse should remove the catheter, elevate the limb, and notify the RN.
The nurse is preparing to administer a mixture of 10 units of regular insulin and 20 units of NPH insulin. Which action should the nurse perform first?
Inject 10 units of air into the regular insulin vial.
Draw up the regular insulin into the syringe.
Draw up the NPH insulin into the syringe.
Inject 20 units of air into the NPH insulin vial.
Explanation
When mixing insulins, the correct sequence is to inject air into the longer-acting (cloudy, NPH) vial first, then inject air into the shorter-acting (clear, regular) vial. After that, withdraw the regular insulin, and then withdraw the NPH insulin. This prevents contamination of the regular insulin with the NPH insulin. Therefore, the very first step is injecting air into the NPH vial.
A primary health care provider has prescribed a 1.5 mL intramuscular injection. The client prefers the injection in the arm. What is the nurse's most appropriate action?
Inform the client that the deltoid muscle is not recommended for this volume.
Ask the client to choose between the ventrogluteal or vastus lateralis site.
Divide the dose into two 0.75 mL injections in the same deltoid.
Administer the full dose into the deltoid muscle.
Explanation
The deltoid muscle is a small muscle and should not receive more than 1 mL of medication per injection to avoid tissue damage and ensure proper absorption. The nurse's most appropriate action is to educate the client about this safety limitation and then proceed to select a larger, more appropriate site like the ventrogluteal muscle. Simply asking the client to choose without providing education is incomplete.
The nurse is preparing to draw medication from a glass ampule. After breaking the neck of the ampule, what is the next step?
Wipe the broken top with an alcohol swab.
Use a filter needle to withdraw the medication.
Turn the ampule upside down and insert a regular needle.
Inject an equal amount of air into the ampule.
Explanation
When an ampule is opened, there is a risk of microscopic glass shards entering the solution. A filter needle must be used to withdraw the medication to prevent these particles from being drawn into the syringe and injected into the client. Air is not injected into an ampule, as it is an open system. Wiping the broken edge is not necessary and could introduce fibers into the medication.