# A 62-year-old patient is being discharged after a deep vein thrombosis and will continue enoxaparin 40 mg SC daily at home. The nurse is teaching self-injection. Which patient statement indicates correct understanding?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A 62-year-old patient is being discharged after a deep vein thrombosis and will continue enoxaparin 40 mg SC daily at home. The nurse is teaching self-injection. Which patient statement indicates correct understanding?

## Option

1. "I will select a spot on my upper arm, clean it with an alcohol swab, inject the medication at a 45-degree angle, and massage the area for 30 seconds to improve absorption."
2. "I will pinch up an inch of skin on my abdomen, two inches away from my navel, push the needle in at a 90-degree angle, and avoid expelling the air bubble before injecting." **✔ Correct answer**
3. "I will choose my thigh for the injection, make sure to expel the air bubble before giving the shot, and then press firmly on the site with gauze without rubbing."
4. "I will rotate injection sites between my abdomen and thighs, and after each injection I will gently massage the area for 30 seconds to help prevent bruising or lump formation."

**Correct answer: 2**

## Explanation

Enoxaparin (low-molecular-weight heparin) self-injection technique: prefilled syringe contains a small air bubble that should NOT be expelled — it ensures the full dose is delivered and seals the medication after injection. Site is the abdomen ("love handles"), at least 2 inches (5 cm) away from the umbilicus. Pinch a fold of skin and inject at a 90-degree angle. Do NOT rub or massage the site, as this increases bruising and hematoma. Choice 1 (upper arm + rubbing), choice 3 (expel air bubble), and choice 4 (massage) all violate established safe-injection technique.

## In-depth explanation

Key teaching points for enoxaparin SC self-injection: (1) Site = abdomen, alternating left and right "love handle" areas, ≥2 inches from umbilicus. Avoid scarred or bruised skin. (2) Do not expel the prefilled air bubble — the bubble follows the medication and ensures complete dose delivery while preventing tracking. (3) Pinch a 1-inch skinfold and hold throughout the injection to prevent intramuscular delivery (which causes hematoma). (4) Inject at 90 degrees, push slowly, hold for 5–10 seconds before withdrawing. (5) Do not rub or massage — apply gentle pressure if bleeding. (6) Bruising is expected, but call provider for unusual bleeding, black stools, severe headache, or epistaxis.

## Clinical scenario

A **62-year-old patient** is being discharged after a **deep vein thrombosis** and will continue **enoxaparin 40 mg SC daily** at home. The nurse is teaching self-injection technique using a **prefilled syringe**.

## Key concepts

- **Low-Molecular-Weight Heparin (LMWH)** — A subgroup of heparin (e.g., enoxaparin, dalteparin) given subcutaneously for VTE prophylaxis or treatment. Predictable pharmacokinetics allow weight-based dosing without routine aPTT monitoring. Anti-Xa level is checked only in renal impairment, pregnancy, or extremes of body weight.
- **Prefilled Air Bubble** — A small air pocket included in enoxaparin prefilled syringes. Patients are taught NOT to expel the bubble — it ensures the full dose is delivered and seals the depot to prevent leakage along the needle track.
- **SC Injection Technique** — Pinch 1-inch skinfold to elevate subcutaneous tissue away from muscle, inject at 90° (45° if very thin), hold pressure briefly without rubbing. Rubbing increases bruising and hematoma; massage is contraindicated.

## Related questions

- [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=en)
- [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en)
- [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en)
- [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en)
- [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en)
- [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en)
- [An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During mornin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372686&lang=en)
- [A 38-year-old female with rheumatoid arthritis is being discharged with a new prescription…](https://mymerci.kr/pages/nclex_q.php?qn_id=372687&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=372707&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._