- Best practice often involves using one needle to draw a medication from a vial and then changing to a new needle before injecting the patient. What is the primary reason for this two-needle technique?
Answer: To ensure the needle used for injection is sterile and sharp.
Piercing the rubber stopper of a vial can dull the needle's tip. Using a fresh, sharp needle for the actual injection reduces patient pain and tissue trauma. This technique ensures the needle administered to the patient is as sterile and sharp as possible.
- Immunization supplies for a single patient typically include the vaccine, a syringe and needle for administration, an alcohol prep pad, a cotton ball or gauze, and:
Answer: an adhesive bandage.
The standard set of ancillary supplies for administering an immunization includes items for preparing the site (alcohol pad), administering the vaccine (syringe/needle), applying pressure post-injection (cotton/gauze), and covering the injection site (adhesive bandage).
- Which of the following syringe and needle combinations is most appropriate for a subcutaneous injection of heparin?
Answer: 1 mL syringe with a 25 G, 5/8-inch needle
Subcutaneous (SC) injections are administered into the fatty tissue below the skin. This requires a shorter needle, typically 1/2 to 5/8 inch, and a higher gauge (thinner) needle, such as 25 G to 30 G, to minimize discomfort. A 1 mL syringe is appropriate for the small volume of a typical heparin dose.
- Which set of supplies is most appropriate for the technician to use for this reconstitution step?
Answer: A 5 mL syringe and a 20 G needle
To accurately measure and transfer 4.8 mL of diluent, the technician should choose the smallest syringe that can hold the entire volume, which is a 5 mL syringe. A 20 G needle is suitable for piercing the vial stopper and transferring the diluent. A 3 mL syringe is too small, an oral syringe cannot be used for sterile injections, and a saline flush is the incorrect diluent.
- Which feature is a critical safety design of an oral syringe that distinguishes it from an injectable syringe?
Answer: Its tip is incompatible with a standard Luer needle hub.
The most important safety feature of an oral syringe is a unique tip design that prevents the attachment of an injectable needle. This engineering control helps eliminate the risk of accidentally injecting a medication that was intended for oral administration. While color and non-sterility can be features, the tip design is the primary safety mechanism.
- After an immunization is administered, the used needle and syringe must be disposed of immediately in which type of container?
Answer: A puncture-resistant sharps container
To prevent needlestick injuries and the spread of bloodborne pathogens, all used needles (sharps) must be placed in a designated, leak-proof, puncture-resistant sharps container. Red biohazard bags are for non-sharp contaminated items, and other containers are unsafe.
- A patient is prescribed testosterone cypionate 1 mL for IM injection every 2 weeks. This medication is viscous. Which supply list is most appropriate for dispensing to the patient for self-administration?
Answer: One 18 G needle, one 23 G, 1 1/2-inch needle, and a 3 mL syringe.
Testosterone is an oil-based, viscous solution. It is common practice to dispense a wider bore needle (e.g., 18 G) for easily drawing the medication from the vial and a separate, thinner needle (e.g., 23 G) for the injection. The 1 1/2-inch length is appropriate for IM injection into the gluteal muscle. A 3 mL syringe is appropriate for a 1 mL dose.
- A technician is gathering supplies to compound a sterile intravenous admixture. What is a common diluent solution used for this purpose?
Answer: 0.9% Sodium Chloride (Normal Saline)
0.9% Sodium Chloride (NS) and 5% Dextrose in Water (D5W) are the most common diluents used to prepare intravenous admixtures because they are isotonic with human blood. Bacteriostatic water contains a preservative and is not for IV use in large volumes. Irrigation solutions are not for injection, and lidocaine is an anesthetic used as a diluent only in specific circumstances (e.g., certain IM injections).
- A pharmacist asks a technician to prepare supplies for an adult patient receiving a standard intramuscular (IM) immunization in the deltoid muscle. Which needle length is most commonly appropriate?
Answer: 1 inch
For an intramuscular injection into the deltoid muscle of an average adult, a 1-inch needle is typically required to ensure the medication is deposited deep into the muscle tissue. A 5/8 inch needle is used for subcutaneous injections, a 3/8 inch needle is for intradermal injections, and a 2-inch needle would be for a patient with a very large amount of adipose tissue.
- When selecting a needle for an injection, the term "gauge" refers to which characteristic of the needle?
Answer: The thickness or diameter of the needle bore.
The gauge of a needle refers to the diameter of its lumen (the hollow bore). A key principle is that the gauge number is inversely related to the diameter; a smaller gauge number indicates a larger needle diameter.
- A technician needs to measure a precise dose of 0.25 mL of a medication for a pediatric patient. Which syringe would allow for the most accurate measurement?
Answer: 1 mL tuberculin syringe
For measuring small and precise volumes, it is best practice to use the smallest syringe that can accommodate the dose. A 1 mL tuberculin syringe is calibrated in hundredths of a milliliter (0.01 mL), providing the greatest accuracy for a 0.25 mL dose. Larger syringes have less precise markings for small volumes, and an insulin syringe is calibrated in units, not mL.
- What is the primary purpose of using a sterile 70% isopropyl alcohol (IPA) prep pad during the preparation of an injectable medication?
Answer: To disinfect the rubber stopper of the medication vial.
Aseptic technique requires that the rubber stopper (septum) of a vial be disinfected before a needle is inserted to prevent contamination of the sterile medication inside. A sterile 70% IPA pad is the standard supply used for this critical step.
- What is the essential piece of equipment required to withdraw medication from a glass ampule to prevent contamination of the final product?
Answer: A filter needle or filter straw
When a glass ampule is broken, microscopic glass particles can fall into the medication. A filter needle or filter straw contains a small filter (typically 5 microns) that removes these particles as the medication is drawn into the syringe, ensuring patient safety.
- A patient requires insulin and has been prescribed Humalog U-100. Which type of syringe must be dispensed for this patient?
Answer: A syringe calibrated for U-100 insulin
Insulin is dosed in units, and its concentration is specified (e.g., U-100 means 100 units/mL). It is critical to use a syringe that matches the insulin concentration to avoid severe dosing errors. For U-100 insulin, a U-100 insulin syringe must be used. Using a tuberculin syringe or a syringe for a different insulin concentration (like U-500) can lead to a dangerous overdose or underdose.
- The primary advantage of a Luer-Lok syringe tip over a slip-tip is that it:
Answer: prevents the accidental detachment of the needle from the syringe.
A Luer-Lok tip has threads that allow a needle to be twisted and securely locked into place. This secure connection is crucial for preventing the needle from disengaging, especially when injecting a viscous medication or applying high pressure.
- A nurse requests supplies to administer a purified protein derivative (PPD) test for tuberculosis. What is the correct route of administration and the appropriate supplies?
Answer: Intradermal; 1 mL syringe with 27 G, 1/2-inch needle
PPD tests are administered via the intradermal (ID) route, just below the surface of the skin. This requires a very small volume (0.1 mL), a small syringe for accuracy (1 mL tuberculin), and a short, fine-gauge needle (e.g., 27 G, 1/2-inch) to ensure proper placement and formation of a wheal or bleb.
- When preparing an injection, the technician should not touch which parts of the syringe and needle to maintain sterility?
Answer: The syringe tip and the entire needle
To maintain aseptic technique, the critical sites that must remain sterile are the syringe tip (where the needle attaches), the needle hub, the needle shaft, and the needle bevel. The inner part of the syringe barrel and the rubber end of the plunger are also critical sterile sites. Touching any of these can introduce microorganisms and contaminate the medication.
- A pharmacist hands a technician a vial and a syringe with a blunt, plastic tip and asks them to draw up the medication. This special needle is known as a:
Answer: blunt fill needle.
A blunt fill needle is a safety device with a blunt tip instead of a sharp bevel. It is designed to pierce the rubber stopper of a vial for medication withdrawal but significantly reduces the risk of accidental needlestick injuries during the compounding process. It is used for preparation only, not for patient administration.
- A technician is preparing an injectable medication and notices small, dark flecks of rubber in the solution after piercing the vial's stopper. This phenomenon is known as:
Answer: coring.
Coring occurs when a piece of the rubber stopper is sheared off by the needle and falls into the medication. It can be prevented by inserting the needle with the bevel facing up at a 45-degree angle, then straightening to 90 degrees as it passes through the stopper. If coring occurs, the vial and its contents must be discarded.
- A pharmacist needs to draw up a very viscous, oil-based medication. To make drawing the medication into the syringe easier, which needle gauge would be the best choice?
Answer: 18 G
Viscous (thick) liquids flow more easily through a needle with a larger bore. Since needle gauge is inversely proportional to diameter, a low gauge number like 18 G represents a large diameter, which is ideal for drawing up thick medications. Higher gauge needles (25 G, 30 G) have a very small bore and would make the task difficult or impossible.
