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A nurse is planning to administer an IM injection into a client's deltoid muscle. Which of the following actions should the nurse take?

A.

Inject the medication 12.7 cm (5 in) below the client's acromion process

B.

Use a 21-gauge needle for the injection

C.

Inject the medication at a 90-degree angle

D.

Inject a volume of less than 2 mL

Answer and Explanation

The Correct Answer is D

A. Injecting the medication 12.7 cm (5 in) below the acromion process is incorrect; the injection site should be approximately 2.5 to 5 cm (1 to 2 inches) below the acromion process.  

 

B. A 21-gauge needle may be appropriate for some IM injections, but a 23- to 25-gauge needle is commonly used for deltoid injections due to the smaller muscle mass.  

 

C. While IM injections into the deltoid are typically given at a 90-degree angle, the volume of medication is the critical factor for this injection site.  

 

D. Injecting a volume of less than 2 mL is correct, as the deltoid muscle can accommodate this amount effectively, while larger volumes should be administered in larger muscles like the vastus lateralis or gluteus medius.


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Correct Answer is C

Explanation

A. Thicken gravies with cornstarch is acceptable as it does not add significant sodium and can be a healthier alternative to flour or other thickening agents.

B. Fresh fruits are indeed a healthy snack option and are encouraged in a heart-healthy diet due to their low sodium and high fiber content.

C. Eating 2 cans of soup a day is concerning because many canned soups are high in sodium, which can exacerbate hypertension. This statement indicates a need for further teaching about sodium intake.

D. Replacing table salt with dried herbs is a positive change that promotes flavor without adding sodium, aligning with heart-healthy dietary recommendations.

Correct Answer is D

Explanation

A. Using each cleansing wipe twice is not appropriate, as this may cause cross-contamination; each wipe should be used once.

B. Cleaning the inside of the container is unnecessary and may introduce contaminants; only the outside should be kept clean.

C. The correct method involves urinating a little, stopping to allow for midstream collection, and then continuing to urinate; saying "then stop" may confuse the procedure.

D. Using the cleansing wipe from front to back is the correct technique for women to prevent urinary tract infections (UTIs) and ensure proper hygiene during sample collection.

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