The nurse should hold the syringe almost against the patient's skin (at about a 15° angle), with the level up while administering a?

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

An intradermal (ID) injection is administered at a shallow 5 to 15-degree angle, almost parallel to the skin.
This technique ensures the medication is deposited directly into the dermis, the layer of skin just below the epidermis.
It is the standard method for sensitivity tests, such as tuberculin (TB) and allergy tests, where a visible local reaction (a wheal or bleb) is necessary for diagnosis.
The small volume of medication (typically 0.01 to 0.1 mL) is absorbed very slowly from the dermis, which is ideal for these diagnostic tests.

Option A: An intramuscular (IM) injection is administered at a 90-degree angle to deliver medication deep into muscle tissue.
Option C: An intrathecal injection is a highly specialized procedure where medication is injected directly into the subarachnoid space of the spinal canal.
Option D: A subcutaneous (SC) injection is administered at a 45-degree or 90-degree angle into the adipose (fat) tissue below the dermis.

Clinical Relevance

Nursing practice connection: Use the key finding related to Parenteral Medication Administration: Injection Angles and Routes to guide bedside assessment, documentation, and the next nursing action.
Using the correct 5 to 15-degree angle for an intradermal injection is critical for the accuracy of diagnostic tests like the Mantoux (TB) test. An incorrect angle can lead to a false result.
Patient safety requires precise technique. Injecting too deeply can cause the medication to enter the subcutaneous tissue, preventing the formation of a wheal and leading to an inaccurate test reading.
What if? If a nurse administers the tuberculin antigen at a 45-degree angle instead of 15 degrees, the substance will enter the subcutaneous tissue. This would likely result in a false-negative reading because the characteristic wheal would not form, and the patient would need to undergo a repeat test, causing delay and unnecessary discomfort.

How to Approach the Question

First, identify the most critical piece of information in the question stem, which is the injection angle: 'at about a 15° angle'.
Recall the standard angles for the common parenteral injection routes taught in nursing fundamentals.
Mentally match the 15-degree angle to the correct injection type. This shallow angle is unique to the intradermal route.
Systematically eliminate the other options by recalling their standard angles: Intramuscular is 90 degrees, and Subcutaneous is 45 or 90 degrees.
Confirm your choice by remembering the purpose of intradermal injections (e.g., TB tests), which require a shallow injection to create a bleb.
Select 'Intradermal injection' as the only option that fits the 15-degree angle described.

Concept Tested & Keywords

Concept Tested: Parenteral Medication Administration: Injection Angles and Routes
Stem keywords: syringe, 15° angle, patient's skin
Lead-in keywords: administering a
Clinical cues: The 15° angle is the defining characteristic for an intradermal injection.

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E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 173-175

E6 Pharmacology Nursing Lilley 11e Part 1 p. 132-134

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