The nurse is to administer an intramuscular injection. The end of ...

[sc00by25]

The nurse is to administer an intramuscular injection. The end of the needle should be inserted to which level?
 
  1. A
  2. B
  3. C
  4. D

Question 2

Twenty minutes after receiving a dose of antibiotic, the patient develops a red, itchy rash. What nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.
 
  1. The nurse should plan to watch for a rash after the next dose is administered.
  2. The nurse should contact the prescriber and relay this assessment information.
  3. The nurse should contact the pharmacy.
  4. The nurse should place an allergy bracelet on the patient.
  5. The nurse should document the presence of the rash in the medical record.

[stano32]

Answer to Question 1

4

Rationale: Intramuscular injections must go into the muscle itself. In this diagram, the muscle is the lowest layer or layer D.

Answer to Question 2

2,3,4,5
Rationale 1: Giving another dose of the antibiotic is not indicated and could have a serious outcome.
Rationale 2: The nurse should discuss this finding with the prescriber as an allergy likely exists.
Rationale 3: Because there is a strong possibility of an allergy, the nurse should contact the pharmacy.
Rationale 4: The nurse should place an allergy bracelet on the patient. If it is determined that the rash is from some other etiology, the bracelet can be removed.
Rationale 5: The nurse should always document the presence of an unexpected finding.
Global Rationale: The nurse should discuss this finding with the prescriber as an allergy likely exists. Because there is a strong possibility of an allergy, the nurse should contact the pharmacy. The nurse should place an allergy bracelet on the patient. If it is determined that the rash is from some other etiology, the bracelet can be removed. The nurse should always document the presence of an unexpected finding. Giving another dose of the antibiotic is not indicated and could have a serious outcome.

[sc00by25]

Excellent

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Gracias!