Pharmacology GI & Nutrition #6

Question

A patient who weighs 91 kg is diagnosed with iron-deficiency anemia and will require injection of iron dextran. How will the nurse prepare and inject the ordered medication? Select all that apply.

Answers

  1. The nurse will draw up the medication, use a 25 gauge needle and inject at a 45 degree angle.
    • Rationale:

      This answer is not correct because IM iron dextran should be given at 90 degrees, not a 45 degree angle. The injection must be at a 90-degree angle, and the site should never be massaged. Use of a 2-inch needle is recommended for patients weighing 200 pounds (91 kg), while 1 ½ -inch needle is recommended for patients weighing less (for instance a patient weighing 110 pounds).

  2. The nurse will draw up the medication, use a 2-inch needle, and inject at a 90-degree angle.
    • Rationale:

      This answer is correct because use of a 2-inch needle is recommended for patients weighing 200 pounds (91 kg), while 1 ½ -inch needle is recommended for patients weighing less (for instance a patient weighing 110 pounds). Pull skin laterally away from the injection site, inject, wait 10 seconds, withdraw, and do not massage.

  3. Pull skin laterally toward the injection site, inject, and withdraw and massage.
    • Rationale:

      This answer is not correct because the nurse should not pull skin laterally toward the injection site, inject, and withdraw and massage. The nurse should pull skin laterally away from the injection site, inject, wait 10 seconds, withdraw, and do not massage.

  4. Pull skin laterally away from the injection site, inject, wait 10 seconds, withdraw, and do not massage.
    • Rationale:

      This answer is correct because the nurse should pull skin laterally away from the injection site, inject, wait 10 seconds, withdraw, and do not massage. The nurse would also draw up the medication, use a 2-inch needle, and inject at a 90-degree angle.

  5. Inject into the deltoid muscle to avoid tissue trauma.
    • Rationale:

      This answer is incorrect because the injection of iron dextran requires a larger muscle than the deltoid. Iron dextran can result in skin and tissue trauma and is more than likely to be deposited into the subcutaneous tissue rather than the muscle. The rate of absorption in the gluteus is also slower than into the deltoid.

Overview

Iron dextran should be given by means of Z-track, using a 2 inch needle since the patient is >200 lbs. The inject should be given at a 90 degree angle and after injected, wait 10 seconds, withdraw, and do not massage.

Explanation

The correct answer is B, D. The medication should be administered via Z-track method to prevent leakage of irritating and discoloring material into the subcutaneous tissues. Lateral displacement away from the injection site helps to seal the drug into the muscle. The injection must be at a 90-degree angle, and the site should never be massaged. Use of a 2-inch needle is recommended for clients weighing 200 pounds (91 kg), while 1 ½ -inch needle is recommended for clients weighing less (for instance a client weighing 110 pounds). Selections A and C are incorrect.

Learning Outcomes

Iron dextran should be administered via Z-track method to prevent leakage of irritating and discoloring material into the subcutaneous tissues. Lateral displacement away from the injection site helps to seal the drug into the muscle. The injection must be at a 90-degree angle, and the site should never be massaged. Use of a 2-inch needle is recommended for patients weighing 200 pounds (91 kg), while 1 ½ -inch needle is recommended for patients weighing less (for instance a patient weighing 110 pounds).

Test Taking Tip

Read the question carefully before looking at the answers: (1) Determine which the question is really asking and look for keywords, (2) read each answer thoroughly and see if it completely covers the material asked by the question, and (3) narrow the choices by immediately eliminating answers you know are incorrect.

Video Rationale