CCMA Pharmacology and Injections 2 — Questions and Answers

Question 1: Which injection technique is used when administering a Mantoux tuberculin skin test (TST)?

Intramuscular at 90 degrees
Subcutaneous at 45 degrees
Intradermal at 10–15 degrees (Correct answer)
Intravenous direct bolus

Correct answer: Intradermal at 10–15 degrees

The Mantoux TST is administered intradermally at a 10–15 degree angle to deposit the tuberculin antigen just below the skin surface, creating a wheal.

The intradermal injection technique is used for the Mantoux tuberculin skin test, allergy testing, and local anesthetics. A small-gauge needle (26–27 gauge) is inserted bevel-up at a 10–15 degree angle just under the epidermis. The injection of 0.1 mL of tuberculin produces a pale, raised wheal (bleb) of 6–10 mm. If no wheal forms, the injection was not intradermal and must be repeated at a different site.

Question 2: A medication order reads: 'Amoxicillin 500 mg PO TID × 10 days.' What does 'TID' mean?

Twice daily
Three times daily (Correct answer)
Four times daily
Every other day

Correct answer: Three times daily

TID is a Latin abbreviation for 'ter in die,' meaning three times daily.

Medical abbreviations for dosing frequency include: QD or QDay (once daily), BID (twice daily), TID (three times daily), QID (four times daily), Q4H (every 4 hours), QOD (every other day), and PRN (as needed). 'PO' means per os (by mouth/oral route). So 'Amoxicillin 500 mg PO TID × 10 days' means: take 500 mg amoxicillin by mouth three times daily for 10 days.

Question 3: Which site is most commonly used for intramuscular injections in adults?

Vastus lateralis
Deltoid (Correct answer)
Ventrogluteal
Dorsogluteal

Correct answer: Deltoid

The deltoid muscle is the most commonly used IM injection site in adults for small-volume injections such as vaccines.

The deltoid muscle (lateral aspect of upper arm) is the preferred site for most adult vaccinations (influenza, hepatitis B, etc.) due to its accessibility and good vascular supply. It accommodates volumes up to 1 mL. The ventrogluteal site is preferred for larger volumes (up to 3 mL) and is considered the safest for IM injections due to distance from major nerves and blood vessels. The vastus lateralis is used for infants and toddlers, and in adults when other sites are unavailable.

Question 4: Which of the following is a Schedule II controlled substance?

Alprazolam (Xanax)
Hydrocodone/acetaminophen (Norco) (Correct answer)
Tramadol (Ultram)
Carisoprodol (Soma)

Correct answer: Hydrocodone/acetaminophen (Norco)

Hydrocodone combination products are classified as Schedule II controlled substances by the DEA due to high potential for abuse and physical dependence.

DEA Schedule II substances have a high potential for abuse that may lead to severe psychological or physical dependence. Examples include opioids (oxycodone, hydrocodone, fentanyl, morphine), stimulants (amphetamine, methylphenidate), and cocaine. Alprazolam and carisoprodol are Schedule IV; tramadol is Schedule IV. Schedule II prescriptions require a written prescription, cannot be refilled, and require strict storage and documentation in medical offices.

Question 5: The Z-track injection technique is used primarily to:

Reduce pain from subcutaneous injections
Prevent medication from leaking back into subcutaneous tissue (Correct answer)
Increase the rate of drug absorption
Deliver medications directly into a vein

Correct answer: Prevent medication from leaking back into subcutaneous tissue

The Z-track technique seals the drug in the muscle by displacing tissue before injection and releasing it afterward, preventing leakage into subcutaneous layers.

The Z-track technique is used for irritating medications such as iron dextran and hydroxyzine. The skin and subcutaneous tissue are pulled 1–1.5 inches laterally before inserting the needle. After injecting the drug and waiting 10 seconds, the needle is withdrawn while maintaining lateral traction, then the tissue is released. This creates a zigzag track that seals the medication in the muscle, preventing tissue staining (especially with iron) and reducing pain and irritation.

Question 6: A patient is prescribed metformin 1,000 mg PO BID. How many total milligrams will the patient take per day?

500 mg
1,000 mg
1,500 mg
2,000 mg (Correct answer)

Correct answer: 2,000 mg

BID means twice daily. 1,000 mg × 2 doses = 2,000 mg per day.

Dosage calculation: 1,000 mg per dose × 2 doses per day (BID) = 2,000 mg/day. This is the maximum recommended daily dose of metformin for type 2 diabetes management. Medical assistants must accurately calculate and verify dosages before administration to prevent medication errors. Always confirm the dose, route, frequency, and patient allergies using the 'rights of medication administration' (right patient, drug, dose, route, time, documentation).

CCMA Pharmacology and Injections 2

Which injection technique is used when administering a Mantoux tuberculin skin test (TST)?