EXAM 4

Question 1

Where is medication injected during an intramuscular (IM) injection?

Answer 1

Into the muscle, below the subcutaneous fat layer.

Question 2

How does the absorption rate of IM injections compare to SQ and IV routes?

Answer 2

Faster than subcutaneous (SQ) injections, slower than intravenous (IV) injections.

Question 3

What are advantages of IM injections?

Answer 3

• Larger volumes can be injected than subcut.
• Wider range of medications can be given IM.
• Some irritating medications can be tolerated better IM.

Question 4

What are disadvantages of IM injections?

Answer 4

• Patient discomfort.
• Risk of injury with poor technique.
• Variation in absorption rates.
• Longer needles may be needed for obese patients.

Question 5

What syringe sizes are typically used for IM injections?

Answer 5

1 mL, 3 mL, or 5 mL syringes.

Question 6

What needle gauge is used for IM injections?

Answer 6

21–25 gauge needles.

Question 7

What needle lengths are typically used for IM injections?

Answer 7

1–3 inches depending on patient size and site.

Question 8

What are the three primary IM injection sites?

Answer 8

• Deltoid
• Ventrogluteal
• Vastus Lateralis

Question 9

Is aspiration recommended before IM injection?

Answer 9

No, aspiration is not necessary according to Cuesta College, CDC, and WHO guidelines.

Question 10

What are common medications administered IM?

Answer 10

• Vaccines (Tetanus, Flu, COVID-19)
• Rhogam
• Vitamin K for newborns
• Antibiotics
• Occasionally opioids and antiemetics

Question 11

What is the proper positioning for a Deltoid IM injection?

Answer 11

Patient seated with arm supported on lap, palm facing upward (supination).

Question 12

What is the maximum volume for Deltoid IM injections?

Answer 12

• Adults: 0.5–1 mL
• Pediatrics: 0.5–1 mL

Question 13

What needle length is used for Deltoid IM injections?

Answer 13

• Adults: 5/8–1 inch (up to 1.5 inches for obese patients)
• Pediatrics: 5/8–1 inch

Question 14

What risks are associated with Deltoid IM injections?

Answer 14

Potential damage to the radial nerve and brachial artery.

Question 15

What is the proper positioning for a Ventrogluteal IM injection?

Answer 15

Patient side-lying or supine.

Question 16

What is the maximum volume for Ventrogluteal IM injections?

Answer 16

• Adults: Up to 3–5 mL
• Pediatrics: Up to 2 mL (varies by age and size)

Question 17

How do you locate the Ventrogluteal injection site?

Answer 17

• Palm over greater trochanter.
• Thumb toward groin.
• Index finger toward anterior iliac spine.
• Middle finger toward iliac crest.
• Inject in the triangle formed between fingers.

Question 18

What are the advantages of using the Ventrogluteal site?

Answer 18

Least painful, free of major nerves/vessels, allows for larger medication volumes.

Question 19

What is the proper positioning for a Vastus Lateralis IM injection?

Answer 19

Patient lying on back with knee slightly flexed.

Question 20

What is the maximum volume for Vastus Lateralis IM injections?

Answer 20

• Adults: Up to 3–5 mL
• Pediatrics: Up to 2 mL (varies by age and size)

Question 21

How do you locate the Vastus Lateralis injection site?

Answer 21

• Place one hand above the knee, one below the greater trochanter.
• Inject in the middle third of the anterior and lateral thigh.

Question 22

What risks are associated with Vastus Lateralis injections?

Answer 22

• Few major nerves/vessels.
• Risk of hitting bone if the muscle is not lifted.

Question 23

How should the nurse inject the IM needle in all sites?

Answer 23

Inject the needle ‘to the hub’ to ensure deep intramuscular delivery.

Question 24

What needle is recommended for drawing up IM medications?

Answer 24

A blunt fill needle.

Question 25

What gauge should be selected for IM injections based on?

Answer 25

The viscosity (thickness) of the medication.

Question 27

What are the three basic functions of the immune system?

Answer 27

Defense against pathogens, Homeostasis by removing damaged cells, Surveillance for mutated cells.

Question 28

What is immunocompetence?

Answer 28

The immune system's ability to recognize, attack, and eliminate foreign substances while sparing the body's own cells.

Question 29

What are antigens?

Answer 29

Foreign substances such as bacteria, viruses, parasites, fungi, or tumor cells that elicit an immune response.

Question 30

What is tolerance in the immune system?

Answer 30

The ability to recognize the body's own cells as 'self' and not attack them.

Question 31

What organs are part of the lymphoid system?

Answer 31

Bone marrow, thymus, spleen, lymph nodes, tonsils, skin-associated lymphoid tissue, GI, GU, and respiratory tracts.

Question 32

What are the physical and chemical barriers of the immune system?

Answer 32

Physical: Skin, mucous membranes, cilia. Chemical: Mucus, tears enzymes, gastric acid, sweat, and sebaceous secretions.

Question 33

What factors affect immune system function?

Answer 33

CNS integrity, emotional state, medications, diet, stress, illness, trauma, surgery, and aging.

Question 34

What is innate immunity?

Answer 34

Non-specific immunity present at birth that provides immediate defense against infection without memory.

Question 35

What cells are involved in innate immunity?

Answer 35

Neutrophils and monocytes.

Question 36

What is acquired immunity?

Answer 36

Immunity developed after exposure to an antigen or through vaccination, involving memory for faster future responses.

Question 37

What is active acquired immunity?

Answer 37

Immunity developed after natural infection or immunization, providing long-term protection.

Question 38

What is passive acquired immunity?

Answer 38

Temporary immunity from transfer of antibodies, such as from mother to fetus or through antibody injections.

Question 39

Where do T cells mature?

Answer 39

In the thymus.

Question 40

Where do B cells mature?

Answer 40

In the bone marrow.

Question 41

What do phagocytes do?

Answer 41

Capture, engulf, and digest pathogens and debris; they also present antigens to activate lymphocytes.

Question 42

What type of T cell directly kills infected or abnormal cells?

Answer 42

Cytotoxic T cells (CD8+).

Question 43

What type of T cell coordinates and stimulates immune responses?

Answer 43

Helper T cells (CD4+).

Question 44

What is the role of suppressor (regulatory) T cells?

Answer 44

They shut down the immune response after pathogens are cleared to prevent overactivity.

Question 45

What is the function of natural killer (NK) cells?

Answer 45

They destroy virus-infected cells, tumor cells, and transplanted graft cells without prior sensitization.

Question 46

What is humoral immunity?

Answer 46

Immunity mediated by B cells producing antibodies that target extracellular pathogens.

Question 47

What is cell-mediated immunity?

Answer 47

Immunity involving T cells and phagocytes that target infected or abnormal cells.

Question 48

What are the five major classes of immunoglobulins and their roles?

Answer 48

IgG (long-term protection, crosses placenta), IgA (mucosal immunity), IgM (first responder), IgD (B cell activation), IgE (allergies and parasites).

Question 49

What are cytokines?

Answer 49

Chemical messengers that regulate immune responses, inflammation, and cell communication.

Question 50

What cytokine stimulates red blood cell production?

Answer 50

Erythropoietin.

Question 51

What cytokine stimulates white blood cell production?

Answer 51

Filgrastim (G-CSF).

Question 52

Which WBC is the first to respond to bacterial infections?

Answer 52

Neutrophils.

Question 53

Which WBC is elevated in allergies and parasitic infections?

Answer 53

Eosinophils.

Question 54

What is a Type I hypersensitivity reaction?

Answer 54

An immediate IgE-mediated reaction, causing anaphylaxis, urticaria, wheezing, or cardiovascular collapse.

Question 55

What is a Type II hypersensitivity reaction?

Answer 55

A cytotoxic reaction where antibodies destroy cells, such as in a transfusion reaction.

Question 56

What is a Type III hypersensitivity reaction?

Answer 56

An immune complex reaction where antigen-antibody complexes deposit in tissues, such as in lupus.

Question 57

What is a Type IV hypersensitivity reaction?

Answer 57

A delayed T-cell mediated response appearing 24–72 hours after exposure, such as contact dermatitis or PPD reaction.

Question 58

What type of reaction is an immediate latex allergy?

Answer 58

Type I hypersensitivity.

Question 59

What type of reaction is a delayed latex allergy?

Answer 59

Type IV hypersensitivity.

Question 60

What virus binds to ACE2 receptors to enter cells?

Answer 60

COVID-19 (SARS-CoV-2).

Question 61

What are the long-term symptoms associated with long COVID?

Answer 61

Fatigue, shortness of breath, memory and concentration issues, sleep disorders, muscle pain, joint pain, chest pain, loss of smell or taste, dizziness, blood clots, organ damage, and worsened symptoms after physical or mental exertion.