# A nurse is preparing and administering injectable medications on a medical-surgical unit. Which actions demonstrate safe injection practices consistent with CDC guidance and the OSHA Bloodborne Pathogens Standard? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372723&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A nurse is preparing and administering injectable medications on a medical-surgical unit. Which actions demonstrate safe injection practices consistent with CDC guidance and the OSHA Bloodborne Pathogens Standard? Select all that apply.

1

Reuse the same syringe with a new needle to draw medication from a multi-dose vial for a second patient to reduce waste

2

Recap the needle with a two-handed technique before disposal to prevent accidental sticks to housekeeping staff

3

Activate the safety mechanism on the syringe only after the patient is transferred from the room to avoid distractions during care

4

Continue using a sharps container after the contents reach the marked fill line to maximize disposal capacity before requesting a replacement

5

Discard the used needle and syringe immediately into a puncture-resistant sharps container at the point of use without recapping

6

Use a single-dose medication vial for one patient only and discard any remaining contents after the procedure, even if medication remains in the vial

## Explanation

Correct: 5, 6. (5) Discard the used needle and syringe immediately at the point of use in a closable, puncture-resistant, leak-resistant, labeled sharps container without recapping. Activate the device's safety feature immediately after use when the device has one. (6) A single-dose vial is intended for one patient during one procedure or injection; leftover contents must not be stored, pooled, or used later. Incorrect: (1) A used syringe is contaminated and must never be used for another patient, even if the needle is changed. (2) Two-handed recapping increases needlestick risk; contaminated needles generally must not be recapped. (3) Delaying activation of a safety feature leaves the exposed sharp hazardous. (4) Sharps containers must be replaced before overfilling and should not be used after contents reach the marked fill line. These practices protect both patients and healthcare workers from bloodborne-pathogen exposure.

## In-depth explanation

Apply the One Needle, One Syringe, Only One Time principle. A needle and syringe used for one patient are discarded together and are never reused for another patient or to re-enter medication that may be used for someone else. Single-dose vials are limited to one patient for one procedure, and leftover contents are discarded. After an injection, activate the engineered safety feature immediately when present and place the sharp directly into an approved container at the point of use without recapping. Replace the container at its marked fill line rather than overfilling it. Multi-dose vials require a new sterile needle and syringe for every entry and should be dedicated to one patient whenever possible.

## Clinical scenario

Medical-surgical unit, morning insulin pass. Patient: 64-year-old with type 2 diabetes, glucose 245 mg/dL pre-breakfast, prescribed 8 units regular insulin SC. Sharps container at bedside is 4/5 full. Nurse has a single-dose insulin vial drawn into a safety-engineered insulin syringe. Roommate also requires regular insulin from a separate vial.

## Key concepts

- **One Needle One Syringe One Patient** — Foundational CDC and OSHA safe injection rule that a syringe used on one patient must never be reused on another patient, even if the needle is changed; violations have caused multiple bloodborne pathogen outbreaks
- **Single-Dose Vial Rule** — Single-dose or single-use vials are designed for entry one time for one patient; remaining drug must be discarded immediately after use to prevent contamination, even if the medication appears to be unused
- **Sharps Container Fill Limit** — Sharps containers must be replaced when filled to no more than three-quarters of capacity to prevent overflow injuries; sharps must be placed at the point of use without recapping or breaking the needle

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