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Chapter 10 Parenteral Administration Intradermal, Subcutaneous, and Intramuscular Routes
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Chapter 10 Parenteral Administration Intradermal, Subcutaneous, and Intramuscular Routes
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Chapter 10: Parenteral Administration: Intradermal, Subcutaneous, andIntramuscular Routes
MULTIPLE CHOICE
1. The nurse is educating a patient about diabetes. Based on recommendations from the
American Diabetes Association, which statement by the nurse is best regarding site rotation?
a. “Insulin injection sites should always be in the abdomen to ensure absorption into the
stomach.”
b. “It is important to rotate injection sites systematically within one area before
progressing to a new site for injection.”
c. “Following exercise, site rotation is not indicated because the circulation in the muscles
will absorb the medication efficiently.”
d. “If you aspirate, site rotation can be done every other day to avoid developing
problems with absorption.”
ANS: B
The American Diabetes Association Clinical Practice recommendations include rotating
injections systematically at one site before progressing to another. Insulin is not absorbed
into the stomach. Failure to rotate sites can result in lipohypertrophy or lipoatrophy. When
subcutaneous (subcut) insulin is administered, aspiration should never be performed.
DIF: Cognitive Level: Application REF: Page 132 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
NOT: CONCEPT(S): Clinical Judgment; Safety; Patient Education
2. Which technique by the nurse is accurate when administering heparin to a thin, older adult
patient?
a. Aspirate before injecting the medication.
b. Inject at a 45-degree angle.
c. Inject at a 90-degree angle.
d. Massage site following injection.
ANS: B
For thin individuals, the skin may need to be pinched and a 45-degree angle used to avoid
administration into the muscle. Heparin should never be aspirated. Subcut injections are
properly administered at a 45-degree angle. The injection site of heparin should never be
massaged.
DIF: Cognitive Level: Application REF: Page 136 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Development
3. The nurse is preparing to administer kindergarten immunizations at the local health clinic.
, Which anatomic site would be best for the injection of the immunizations containing 0.5 mL?
a. Rectus femoris
b. Dorsogluteal
c. Deltoid
d. Ventrogluteal
ANS: C
The deltoid muscle is often used because of its easy access and the fact that it can tolerate
0.5 mL of medication volume. Having the child disrobe is not efficient in this setting.
DIF: Cognitive Level: Application REF: Page 138 | Page 139
OBJ: 5 TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Development
4. A 65-year-old man who weighs 180 lb (81.8 kg) is to receive 1.5 mL of a viscous antibiotic by
intramuscular (IM) injection. Which needle and syringe will be used?
a. 5 /8 inch, 25-gauge needle with 5 mL
syringe
b. 1 inch, 28-gauge needle with 4 mL syringe
c.
1 inch, 21-gauge needle with 3 mL syringe
d. 3 inch, 16-gauge needle with 1.5 mL syringe
ANS: C
It is important to correlate the syringe size to the size of the patient and the tissue mass. The
usual amount injected intramuscularly is 0.5 to 2 mL. Needle lengths commonly used for
adults are 1 to 1 inches long. A longer needle may be used for a significantly obese
adult. Commonly used needle gauges for IM injections are 20 to 22 gauge. A 5/8 inch, 25-
gauge needle is too short and too small to administer a viscous medication. A 1 inch, 28-
gauge needle is too small to administer a viscous medication. A 3 inch, 16-gauge needle is too
large and too long to administer medication to a patient this size.
DIF: Cognitive Level: Application REF: Page 136 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity NOT:
CONCEPT(S): Clinical Judgment; Safety
5. Which is the preferred IM site for injecting a 6-month-old child?
a. Dorsogluteal
b. Abdominal
c. Vastus lateralis
d. Deltoid muscle
ANS: C
The vastus lateralis is generally the preferred IM site in infants because it has the largest
muscle mass for that age group. The muscles are not well developed in other areas for this
age group. The dorsogluteal muscle is not developed well enough in a child this age to
provide a safe site for injection. The abdominal muscles are not appropriate for IM injection.
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