Chapter 08: Injectable Medications

Mulholland: The Nurse, The Math, The Meds, 3rd Edition

ESSAY
1. What is the usual dose in mL for a skin test?
ANS:

0.1 mL
2. A skin test is administered with which size syringe?
ANS:

1 mL tuberculin syringe
3. Would a small gauge or a large gauge needle be used for a skin test?
ANS:

Small
4. What is the name and abbreviation for the route used for skin test injections?
ANS:

I.D.
5. What is the descriptor for medications that, when combined in one syringe or solution,

interact and cause undesired changes in composition or effect (such as crystallization)?

ANS:

incompatibility
6. Name the three approved sites for intramuscular injections.
ANS:

deltoid, vastus lateralis, and ventrogluteal

7. What is the first step a nurse must take after reading an order for a parenteral injection mix?
ANS:

Check for compatibility.

8. What is the name of the kind of reference a nurse must consult before mixing two or more

medications in one syringe or IV solution?

ANS:

A current compatibility reference chart (or check with the pharmacist)

9. What is the reason for mixing two or more medications in one syringe for an intramuscular

injection?

ANS:

To avoid unnecessary trauma and discomfort from multiple injections.

10. Which size zone should be avoided around umbilicus when giving abdominal subcutaneous

injections?
ANS:

A 2-inch diameter around umbilicus is to be avoided.

11. Does the nurse have to measure the dose in a prefilled syringe? If so, why; if not, why not?
ANS:

Yes. The dose must be measured. The dose needed may be less than the amount in the
prefilled syringe. There is often a little air and extra medication in the prefilled syringe.
12. An error of dosage with one decimal place, such as preparing 1 mL instead of 0.1 mL results

in how much of an error?

ANS:

The error is 10 times more or less than ordered dose. This can cause a fatal adverse drug event
(ADE).
13. What is the importance of writing a leading 0 in front of a decimal number less than one?
ANS:

A leading zero (e.g., 0.2) alerts the nurse that a decimal is to follow. Decimals are often not
well-visualized.
14. What is the value of estimating medication doses before calculation and preparation?
ANS:

Estimating doses is one very important way to catch a major math calculation error.
15. Can the nurse legally administer a medication after the expiration date?
ANS:

No, the medication must be discarded. It may no longer be effective and could have
decomposed and have bacterial contamination.
16. Which site is not recommended for intramuscular injections? Why?
ANS:

The dorsogluteal, which is the upper outer quadrant of the buttock, is no longer recommended.
The location of the sciatic nerve varies from patient to patient. An injection into the sciatic
nerve can cause permanent disability.
17. What are the two most common diluents for injectable medications?
ANS:

SW for injection and sterile NS for injection are the two most common diluents for injectable
medications.

18. State the approved abbreviations for four parenteral routes.

ANS:

ID; subcut; IM, IV

19. Why shouldnt needles be recapped?
ANS:

The risk of a needlestick injury is high when recapping needles. This could result in
contraction of viral illnesses, such as hepatitis or AIDS. Promptly dispose of the used syringe
and needle in agency-supplied hazardous waste sharps containers.
20. How does the nurse decide how much to round a dose for an injectable medication?
ANS:

The most appropriate available equipment and its characteristics (for injections, syringe size,
and calibration) determines the nearest measurable dose that can be administered.
21. What is the purpose of a filter needle? When is it used?
ANS:

A filter needle is used to withdraw medications from glass ampules to filter out small glass
particles that may have fallen in the ampule when the top was broken off. The filter needle
must be exchanged for a sterile regular needle before administration of the medication.
22. Ordered: meperidine 60 mg IM stat, for a patient complaining of postoperative pain.

Available:

How many milliliters will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:
Indicate with an arrow the amount to be added to the syringe with the nearest measurable
dose.

ANS:

a. Estimate: Slightly more than 1 mL

b.
c. Equation is balanced. Estimate supports answer.

23. Ordered: cimetidine HCl 0.4 g IM bedtime daily, for a patient with a gastric ulcer.

Available:

a. What is the trade name for this medication?

How many milliliters will the nurse prepare?
b. Estimated dose:
c. DA equation:
d. Evaluation:
Indicate with an arrow the amount to be added to the syringe with the nearest measurable
dose.

ANS:

a. Tagamet
b. Estimate: More than 2 mL. Less than 4 mL. (0.4 g = 400 mg)
c.
d. Equation is balanced. Estimate supports answer.

24. Ordered: digoxin 300 mcg IM stat, for a patient with heart failure.

Available:

How many milliliters will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:
Indicate with an arrow the amount to be added to the syringe with the nearest measurable
dose.

ANS:

a. Estimate: Slightly more than 1 mL (300 mcg = 0.3 mg)

b.

c. Equation is balanced. Estimate supports answer.

25. Ordered: furosemide 25 mg IM stat, for a patient with edema.

Available:

How many milliliters will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:
Indicate with an arrow the amount to be added to the syringe with the nearest measurable
dose.

ANS:

a. Estimate: Less than 4 mL. More than 2 mL.

b.
c. Equation is balanced. Estimate supports answer.

26. Ordered: diazepam 12 mg stat IM, for a patient experiencing anxiety.

Available:

How many milliliters will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:
Indicate with an arrow the amount to be added to the syringe with the nearest measurable
dose.

ANS:

a. Estimate: Slightly more than 2

1 mL (2 mL)

b.
c. Equation is balanced. Estimate supports answer.

27. Ordered: Nembutal 75 mg IM at bedtime prn sleep.

Available:

How many milliliters will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:
Indicate with an arrow the amount to be added to the syringe with the nearest measurable
dose.

ANS:

a. Estimate: More than 1 mL. Less than 2 mL.

b.
c. Equation is balanced. Estimate supports answer.

28. Ordered: morphine sulfate, 15 mg; atropine, 0.3 mg; IM stat, for a preoperative patient.

Available:

How many milliliters of morphine sulfate will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:

How many milliliters of atropine will the nurse prepare?

d. Estimated dose:
e. DA equation:
f. Evaluation:
g. How many milliliters will be given in total?
Indicate with an arrow the total dose on the syringe. Draw a line through the atropine dose.

ANS:

a. Estimate: More than 1 mL. Less than 2 mL.

b.
c. Equation is balanced. Estimate supports answer.
d. Estimate: Less than 1 mL
e.
f. Equation is balanced. Estimate supports answer.
g.
1.5 mL

+0.8 mL
2.3 total mL

29. Ordered: vitamin B12 injection IM 80 mcg once a week, for a patient with a folate deficiency.

Available:

How many milliliters will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:
ANS:

a. Estimate: Less than 1 mL. More than 0.5 mL.

b.
c. Equation is balanced. Estimate supports answer.
30. Ordered: hydromorphone HCl, 3 mg; hydroxyzine, 40 mg; IM stat.

Available:

How many milliliters of hydromorphone will the nurse prepare?

a. Estimated dose:
b. DA equation:
c. Evaluation:

How many milliliters of Vistaril will the nurse prepare?

d. Estimated dose:
e. DA equation:
f. Evaluation:
g. Total combined milliliters to be administered:
Indicate with an arrow the total dose on the syringe. Draw a line through the Vistaril dose.

ANS:

a.

b.
c. Equation is balanced. Estimate supports answer.
d. Estimate: Less than 1 mL. More than 0.5 mL.
e.
f. Equation is balanced. Estimate supports answer.
g. 0.8 mL
+0.8 mL
1.6 total mL

31. Ordered: morphine sulfate 3 mg; atropine 0.2 mg; subcut for a patient preoperatively.

Available:

a. What is the apothecary equivalent of the available 4 mg?

How many milliliters will the nurse prepare?
b. Estimated dose:
c. DA equation:
d. Evaluation:

How many milliliters will the nurse prepare?

e. Estimated dose:
f. DA equation:
g. Evaluation:

h. How many milliliters will be given in total?

Indicate with an arrow the total dose on the syringe. Draw a line through the atropine dose.

ANS:

a.
b. Estimate: Less than 1 mL. More than 0.5 mL.
c.
d. Equation is balanced. Estimate supports answer.
e. Estimate: Half of 1 mL 0.5 mL
f.
g. Equation is balanced. Estimate supports answer.
h. 0.8 mL
+0.5 mL
1.3 total mL