AIIMS Delhi NO - 2017
Medical Surgical Nursing
Hard
A nurse gave an injection of ondansetron to a patient. After 10 minutes, the patient's finger became blue in color. This is because of?
Appeared in: AIIMS Delhi NO - 2017
Explanation
- The blue discoloration (cyanosis) of a finger following an injection near the wrist or arm is a classic sign of compromised arterial blood flow.
- An accidental injection into an artery triggers an intense inflammatory reaction, vasospasm (constriction), and potential thrombus (clot) formation.
- This blockage obstructs oxygenated blood from reaching the distal tissues, leading to ischemia and the visible blue color.
- This is considered a medical emergency as it can rapidly progress to tissue necrosis and gangrene if circulation is not restored.
Why Other Options Were Wrong
- Option B: This is the intended route of administration. A correctly placed intravenous injection delivers medication into the venous system and would not cause acute, localized ischemia in a finger.
- Option C: The known side effects of ondansetron are primarily systemic (e.g., headache, constipation, dizziness, QT prolongation). Localized peripheral cyanosis is not a recognized pharmacological side effect of the drug.
- Option D: Cyanosis is never a normal effect of any medication administration. It is an alarming sign that indicates severe circulatory or respiratory compromise and requires immediate investigation and intervention.
Related Visual
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Complications of Parenteral Medication Administration in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- This scenario highlights the critical importance of anatomical knowledge and careful technique during venipuncture, especially in areas like the antecubital fossa where arteries lie close to veins.
- Nurses must be able to rapidly recognize the signs of an accidental arterial injection (the 5 P's: Pain, Pallor, Pulselessness, Paresthesia, Paralysis) and escalate care immediately to prevent permanent limb damage.
- Immediate action includes stopping the injection, notifying the provider, and preparing for emergency interventions. Leaving the cannula in place may be requested by the provider to administer vasodilating medications directly to the site.
How to Approach the Question
- First, identify the key clinical finding in the question: a patient's finger turned blue after an injection.
- Recognize that a blue color (cyanosis) is a sign of insufficient oxygen, which points to a problem with blood circulation.
- Analyze the options in relation to the circulatory system. The problem is localized to a finger, suggesting a vascular event in the arm where the injection was given.
- Differentiate between a systemic drug side effect and a localized procedural complication. A single blue finger is highly indicative of a local event, not a systemic reaction.
- Evaluate the vascular routes. An injection into an artery, which supplies blood to the hand, would directly cause distal ischemia if blocked. An injection into a vein, which drains blood from the hand, would not cause this specific outcome.
- Conclude that the only plausible explanation for an acute cut-off of blood supply to the finger is an accidental injection into an artery.
Concept Tested & Keywords
- Concept Tested: Complications of Parenteral Medication Administration
- Stem keywords: injection, ondansetron, finger, blue in color
- Lead-in keywords: because of
- Clinical cues: The patient's finger turning blue after an injection is a critical sign of acute limb ischemia.
- Negative lead-in flag: false
Question ID
QsmA6AoB-fIZHoer60QzoO
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 3 pp. 135-137, 203-205
Practise the full AIIMS Delhi NO - 2017
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Administration of Medication Questions
- What is the major nursing responsibility when administering sulfonamide preparation?
- Which is the appropriate site to administer Intramuscular injections in children?
- Which of the following combination is incompatible?
- To ensure accurate medication administration and prevent errors, what is the most comprehensive method for verifying a patient's identity?
- The nurse selects routes for administering medication according to?
- The reason for using the parenteral route to administer medication includes?
- The nurse is to administer Iron injection to an adult. How can it be administered?
- Commonest site used for IM injection in infant is?
- A nurse keeps in mind while giving heparin injection to a patient?
- Method used to give Haloperidol injection?
More AIIMS Delhi NO - 2017 Questions
- Which is a live attenuated vaccine?
- The injection haloperidol is given intramuscularly by which technique?
- One of the most initial things that should be done by a nurse while going to a home visit?
- Most common type of shock in a trauma patient?
- Intraspinal medication is given in which IVD space?
- Most common cause of hypotension in trauma patients?
- Which blood group can be used in an emergency or when the desired blood group is not available?
- CSF draining from the nose and ear occurs in which type of skull fracture?
- Which characteristic of stool indicates normal functioning of an ascending colostomy?
- Allen test should be performed before?