1. An older, frail patient is prescribed a flu vaccine that is an aqueous or water-based solution. The patient’s deltoid muscle is not very prominent, and the patient has very little fat over the deltoid. The needles available are 23 G 5⁄8-inch, 22 G 1-inch, and 20 G 1 1⁄2-inch. What needle size/length would work best for this particular medication and patient? Give the reason for your selection.

2. A patient is hospitalized on the surgical floor. Pain medication is prescribed to be given by intramuscular route. After calculating, the volume to be administered is 2 mL. The patient has a large amount of adipose tissue around her hips and buttocks region and weighs 253 pounds. The needle sizes available include 27 G 3⁄8-inch, 25 G 5⁄8-inch, 22 G 1-inch, 21 G 1 1⁄2-inch, and 20 G 2-inches. What needle size/length and injection site would work best for this particular medication and patient? Give the reason for your selection.

3. The nurse is teaching a patient how to mix 5 units of regular insulin and 15 units of NPH insulin in the same syringe. The nurse determines further instruction is needed if the patient does which of the following?

1. Injects 5 units of air into the regular insulin vial first and withdraws 5 units of regular insulin
2. Injects 15 units of air into the NPH insulin vial but does not withdraw the medication
3. Withdraws 5 units of regular insulin before withdrawing 15 units of NPH insulin
4. Calculates the combined total insulin dose as 20 units after withdrawing the regular insulin from the vial