Which of the following drug administration route is most preferable for the following drug? & x20; - NORCET 6 mains-2024

NORCET 6 mains-2024

Pharmacology

Hard

Appeared in: NORCET 6 mains-2024

Explanation

The drug identified in the image is 50% Dextrose (D50), a hypertonic solution with an extremely high osmolarity (approx. 2,525 mOsm/L).
Administering such a concentrated and irritating solution requires rapid dilution to prevent damage to the blood vessel's inner lining (tunica intima).
A central line terminates in a large, high-flow vein (like the superior vena cava), which provides immediate and substantial dilution of the drug.
This rapid dilution makes the central line the safest and therefore the most preferable route, minimizing risks of phlebitis and thrombosis.

Option A: Injecting a highly hypertonic solution like D50 into muscle tissue is contraindicated. It would draw fluid from surrounding cells, causing severe pain, inflammation, and tissue necrosis (death).
Option B: This route is contraindicated for D50. Injecting this hypertonic solution into the fatty subcutaneous tissue would lead to severe irritation, pain, and tissue necrosis.
Option D: This is not the most preferable route. Administering a solution with such high osmolarity through a small peripheral vein carries a significant risk of chemical phlebitis, thrombosis, and severe tissue damage if extravasation (leakage) occurs.

Visual 1: Diagram: Comparison of a peripheral IV line in a hand/arm vein versus a central venous catheter terminating in the superior vena cava. This illustrates the difference in vein size and blood flow.
Visual 2: Image: Clinical photograph of chemical phlebitis, showing redness, swelling, and a palpable cord along a vein, to demonstrate the potential complication of peripheral administration of irritant solutions.

Clinical Relevance

Nursing practice connection: Knowing Administration of Hypertonic IV Solutions helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must verify the correct route for hypertonic solutions and advocate for central line placement for patient safety when indicated, as per institutional policy and standards of care.
Constant monitoring of any IV site for signs of infiltration (swelling, coolness, pain) or phlebitis (redness, warmth, pain, streak formation) is a critical nursing responsibility.
In the event of extravasation of a vesicant like D50, the infusion must be stopped immediately, and specific protocols for managing the tissue injury must be initiated.

How to Approach the Question

First, identify the drug shown in the image: '50% Dextrose Injection'.
Next, recall or deduce the key property of this drug. A 50% concentration of dextrose is highly concentrated and therefore a hypertonic solution.
Consider the physiological effect of administering a hypertonic solution via each of the listed routes.
Evaluate the risks associated with each route. Intramuscular and subcutaneous routes risk tissue necrosis. A peripheral line in a small vein risks chemical phlebitis and extravasation injury.
Evaluate the safety of the remaining option. A central line delivers the solution into a large vein with high blood flow, providing rapid dilution and minimizing vessel damage.
Conclude that the route offering the highest safety profile and lowest risk of complications for this specific drug is the 'most preferable' one.

Concept Tested & Keywords

Concept Tested: Administration of Hypertonic IV Solutions
Stem keywords: drug administration route, most preferable, 50% Dextrose Injection
Lead-in keywords: most preferable
Clinical cues: Image shows 50% Dextrose, a highly hypertonic solution

QcSDwCjNWouej13cpVFZFz