A nurse must give an intramuscular injection of pain medication to a patient who has suffered a fracture in his left arm. Which of the following situations would be a contraindication to administering medication in this manner? Select all that apply.

 

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Correct

- The dose of the drug is over 2 mL

- The patient is uncooperative

- A known reaction to the medication

- The drug follows thrombolytic therapy

- A birthmark is at the site of injection

Rationale

"A known reaction to the medication", "The drug follows thrombolytic therapy" and "A birthmark is at the site of injection" are correct. Any time the patient has a known reaction to a medication, the medication should be avoided. If the patient has received thrombolytic therapy, an IM injection is contraindicated because of the increased bleeding potential. Other situations in which the nurse should not give an IM injection include if there is redness, inflammation, bleeding, or a birthmark over the injection site. An intramuscular injection can be a great alternative to swallowing a tablet or for the nurse to start an IV if the patient needs medication quickly.
"The does of the drug is over 2 ml" is incorrect because IM injections, depending on the injection site, can be given up to 5 ml.
"The patient is uncooperative" is incorrect, because in a emergent situation the nurse may have to give the drug as a medical necessity. She may need to ask for help from another staff member, but she can still give the IM injection.

References:
Hopkins, U., & Aria, C. (2013, December 17). Large-volume IM injections: 
A review of best practices. Retrieved March 29, 2018, from https://www.oncologynurseadvisor.com/chemotherapy/large-volume-im-injections-a-review-of-best-practices/article/281208/

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