6 Most Common Mistakes of New Nurses    B.Sc Nursing 2nd Year Question Bank PDF Available

Saturday, February 27, 2021

RGUHS 2nd Year B.Sc Nursing Question Bank, Blueprint PDF

RGUHS 2nd Year Question Bank, Blueprint

RGUHS 2nd Year B.Sc Nursing Question Bank

RGUHS 2nd year question bank, blueprint includes - 
1. Sociology - QP Code : 1760
2. Medical Surgical Nursing - 1 - QP Code : 1761
3. Pharmacology, Pathology and Genetics - QP Code : 1762 & 1763
4. Community Health Nursing - 1 - QP Code : 1764
5. Communication and Educational Technology - QP Code : 1765

Sociology Question Bank, Blueprint - QP Code : 1760

Sociology Unit Wise Questions -

Long Essays :
   Unit 6 - Family and marriage
   Unit 12 - Social problems
Short Essays :
   Unit 1 - Introductions
   Unit 4 - Social groups and social processes
   Unit 5 - Population
   Unit 7 - Social stratification
   Unit 8 - Types of communities in India
   Unit 9 - Social change
Short Answers :
   Unit 2 - Individual and society
   Unit 3 - Culture
   Unit 4 - Social groups and social processes
   Unit 7 - Social stratification
   Unit 8 - Types of communities in India
   Unit 10 - Social system
   Unit 11 - Social control
   Unit 12 - Social problems

Sociology Marks Distribution for RGUHS exam -

   Long Essays (10 marks each) × 2 = 20 marks
   Short Essays (5 marks each) × 7 = 35 marks
   Short Answers (2 marks each) × 10 = 20 marks

Download Sociology Question Bank, Blueprint -

Medical Surgical Nursing - 1 Question Bank, Blueprint - QP Code : 1760

Medical Surgical Nursing - 1 Unit Wise Questions -

• Long Essays :
• Short Essays :
• Short Answers:

Medical Surgical Nursing - 1 Marks Distribution for RGUHS exam -

   Long Essays (10 marks each) × 2 = 20 marks
   Short Essays (5 marks each) × 7 = 35 marks
   Short Answers (2 marks each) × 10 = 20 marks

Download Medical Surgical Nursing - 1 Question Bank, Blueprint -

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Pharmacology, Pathology and Genetics Question Bank, Blueprint - QP Code : 1762 & 1763

Pharmacology Unit Wise Questions -

Long Essays :
   Unit 9
Short Essays :
   Unit 2, Unit 10, Unit 11, Unit 12.
Short Answers :
   Unit 1, Unit 3, Unit 4, Unit 5, Unit 6, Unit 7, Unit 8.

Download Pharmacology Question Bank, Blueprint -

Pathology Unit Wise Questions -

• Long Essays :
   Unit 2 - Special pathology
• Short Essays :
   Unit 1 - Introductions
   Unit 2 - Special pathology
   Unit 3 - Clinical pathology
   Unit 4 - Examination of body cavity fluids, transudates and exudates
   Unit 5 - Urine and faeces
• Short Answers:
   Unit 3 - Clinical pathology

Download Pathology Question Bank, Blueprint -

Genetics Unit Wise Questions -

• Long Essays : Nil
• Short Essays : Nil
• Short Answers:
   Unit 1 - Introductions
   Unit 2 - Maternal, prenatal and genetics on development of defects and disease
   Unit 3 - Genetic testing and screening
   Unit 4 - Genetic conditions of adolescents and adults
   Unit 5 - Services related to genetics

Download Genetics Question Bank, Blueprint -

Pharmacology, Pathology and Genetics Marks Distribution for RGUHS exam -

   Long Essays (10 marks each) × 2 = 20 marks
   Short Essays (5 marks each) × 7 = 35 marks
   Short Answers (2 marks each) × 10 = 20 marks

Community Health Nursing - 1 Question Bank, Blueprint - QP Code : 1764

Medical Surgical Nursing - 1 Unit Wise Questions

• Long Essays -
   Unit 2, Unit 4, 
• Short Essays -
   Unit 1, Unit 2, Unit 3, Unit 4, Unit 5, Unit 6, Unit 7.
• Short Answers -
   Unit 1, Unit 2, Unit 3, Unit 4, Unit 5, Unit 6, Unit 7.

Community Health Nursing - 1 Marks Distribution for RGUHS exam -

   Long Essays (10 marks each) × 2 = 20 marks.
   Short Essays (5 marks each) × 7 = 35 marks.
   Short Answers (2 marks each) × 10 = 20 marks.

Download Community Health Nursing - 1 Question Bank, Blueprint -

Communication and Educational Technology Question Bank, Blueprint - QP Code : 1765

Communication and Educational Technology Unit Wise Questions -

Long Essays :
   Unit 6 - Methods of teaching
   Unit 7 - Educational media
Short Essays :
   Unit 3 - Human relations
   Unit 4 - Guidance and counselling
   Unit 6 - Methods of teaching
   Unit 7 - Educational media
   Unit 8 - Assessment
Short Answers :
   Unit 1 - Communication
   Unit 2 - Interpersonal relationship
   Unit 4 - Guidance and counselling
   Unit 5 - Education and teaching learning process
   Unit 6 - Methods of teaching
   Unit 9 - IEC

Communication and Educational Technology Marks Distribution for RGUHS exam -

   Long Essays (10 marks each) × 2 = 20 marks.
   Short Essays (5 marks each) × 7 = 35 marks.
   Short Answers (2 marks each) × 10 = 20 marks.

Download Communication and Educational Technology Question Bank, Blueprint -

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RGUHS 1st Year B.Sc Nursing Question Bank, Blueprint

RGUHS 3rd Year B.Sc Nursing Question Bank, Blueprint

RGUHS 4th Year B.Sc Nursing Question Bank, Blueprint

Thursday, November 26, 2020

Staff Nurse Vacancy 2020-2021 | Apollo Home HealthCare Limited

Staff Nurse Vacancy 2020-2021

Staff Nurse Recruitment 2020-2021, Vacancy 150, Salary ₹15000-30000/month  

Apollo Home Healthcare Limited needs GNM and B.Sc nursing staff nurses in 2020-2021 season. The total vacancy is 150. Nature of job - full-time staff nurse.

This full-time job is posted in the National Career Service website (Government of India) and job id : 15Q62-1603020534380J
Please check your eligibility for this full-time job and start to apply.

 Job Details :

Job Title Home Care Nurse
Company Name Apollo Home HealthCare Limited
Organisation Type Company
Sector Health
Functional Area Health Care
Functional Role Nurse
Number of Openings 150
Salary (₹) 15000-30000/month

 Required Qualifications :

Minimum Qualification 12th Pass
Key Skills GNM Nursing, B.Sc Nursing
Total Experience 1 - 6 Years

 Additional Information :

Job Location Kolkata, West Bengal
Nature of Job Full Time
Salary (₹) 15000-30000
Salary Type Monthly
Last Date to Apply 05/01/2021
Gender Preferences Any
Ex-Servicemen Preferred No
Number of Openings 150

 Job Description :

• To maintain nursing profession standards of expertness along with recent and best nursing practices.
• To ensure that the cares for the each patient are according to the care plan.
• To ensure that the cares are performed for the all patients are According to the company clinical policies and procedures.
• To ensure and promote the patient's safety, privacy,  confidentiality and dignity at all the times.
• To ensure that all the informations and treatments for the patient's are recorded correctly during the care was delivered.
• To ensure professional manner and communication with referring clinician.
• To maintain professional cooperation with other health care personnels.
• To participate in any quality assurance program.

Please wait 15 seconds to Apply.

Note - Please check last date of application and all the job details once again from the respective official website.

 Share Now with your friends and colleagues before it expires.

Sunday, October 11, 2020

How to Support Mental Health at Workplace for Nurses

How to support Mental Health at Workplace for Nurses,
Image Source - Pixabay  
Nowadays, we are more conscious of our health. We know the methods and habits to improve our physical health in daily life such as exercise, meditation, healthy diet, avoiding smoking and alcohol etc.

But even though we are improving our physical health, we still not conscious of our mental health. Mental health is an important part of our healthy lifestyle. We cannot skip it because we are not completely healthy if we have mental health problems.

Your mental health can be depended upon your lifestyle, career, workplace, relationship, society, genetic factors and so on. Whatever the situation we are facing, we have to improve our mental health.

During our busy life, workplace and daily job routine make us more irritate and depressed. But we cannot stop our job, instead, we can improve our mental health. By improving mental health we will feel more peaceful, comfortable, energetic and healthy.

So, in this article, we will focus on mental health problems related questions and

How to Support Mental Health at Workplace for Nurses

What are the characteristics of mental health problems?

In our daily life, sometimes we experience stress, fear and upset. Most of the time these feelings do not exist for prolong time but sometimes it develops further and turns into mental health problems. 

The common characteristics of mental health problems are -

   • depression

   • aggressiveness

   • lack of interest

   • feelings of hopelessness

   • irritability

   • lack of concentration

   • thought of decreased self-worth

   • drug abuse

   • doing high-risk activities

   • thought of suicide.

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How to identify an individual with mental health problems?

An individual with mental health problems has some changes which are different from a healthy individual. The changes can be because of a stressful life.

A nurse experiences a lot of stress throughout his/her prolong duty time. They provide continuous health care and support to the patients, manage patient's records and deal with administrative. These lot of stressful duties make the nurses irritate, depressed, tired and sad.

The regular stressful situations can develop into mental health problems. During this period, the individual shows some abnormal changes in his/her behaviour, speech and lifestyle. We can identify an individual with mental health problems by observing the changes very carefully.

Some common changes in mentally ill individuals are -

   • Feelings of hopelessness and decreased self-worth.

   • Feelings of sad, guilty and excessive fears.

   • Reduced concentration ability and confused thinking.

   • Avoiding communication from friends and social isolation.

   • Disturbed sleeping pattern, tiredness and anxiety.

   • Unable to cope with stress and daily problems.

   • Major changes in diet pattern.

   • Thoughts of violence, excessive anger and drug abuse.

   • Thoughts of suicide.

Why mental health is important in the workplace?

Workplace stress is common for health care staffs and even for all types of employees. In such a condition, we cannot skip our workplace or job but we can improve our mental health.

Most of the workplaces or organizations have enough arrangements but they don't think about employees' health. In few organizations have physical health service facilities for the employees. But only the wellness of physical health is not enough. We must focus on mental health.

The success of an organization builds upon the quality services and hard works of the employees. So, employees' health and wellness are important factors for an organization's development.

If an employee is stressed or depressed, it affects the employee's skills and knowledge. Because of their disturbed mental status, they cannot utilize their skills and knowledge for the organization's development. So, mental health has an important role in the organization's growth and development.

Apart from the organization, workplace stress disturbs an employee's personal life and behaviour. Due to regular stress and workload, they become depressed and mentally ill. So, the organization should have a facility for mental health wellness.

How to improve your mental health?

We can protect ourselves from workplaces stress by improving our mental health. We should know some self-care habits and practices to support mental health.

Here are 5 effective ways for you to improve your mental health at the workplace.

1. Express your feelings -

Expressing your feelings can help you to deal with upset feeling and improve your mental health status. It is an effective way to support mental health.

At our workplace, we are facing a lot of stressful works and situations. Sometimes we feel upset, lack of interest, irritation, loneliness. On that situation, we should express our feelings to our colleagues, friends, family and loved one.

Take a break between your works and spend some times to relax. 

Expression of your feelings to others will help to reduce stress, provide encouragement and energy.

2. Do exercise and physical activity -

Daily and regular exercise can boost your physical strength along with physiological functions. It will help you to relax your mind, concentrate on works, increase interest and adequate sleep.

You should make a habit of doing exercise regularly for at least 30 minutes. Practice yoga and meditation to relax your mind.

Along with your exercise, do some physical activity which you like. Exercise and physical activity will increase oxygen saturation level and blood circulation to your brain.

3. Sleep adequately -

Sleeping has an important role in your mental health. It helps to relax your brain and mind.

According to mayoclinic, the recommended sleeping time for an adult is 7 to 9 hours. If you want to irritate free, sleep adequately daily.

The healthy sleeping pattern helpful to improve your mental health. Lack of sleeping can make you irritated, stressed, anxious and aggressive.

4. Have healthy meals -

Most of the people don't bother about their meals. But eating habit can affect your physical and mental health.

Try to have healthy meals such as vegetables, fruits, seafood etc. Along with this, you must drink enough water to stay hydrated.

It is not easy to maintain a healthy diet pattern at work but set a time for your meal. If you are not getting healthy food at work, try to bring foods from home.

Try to avoid caffeine when you are feeling stressed. Instead of caffeine drink water, fruit juice or fresh fruits.

5. Take a break -

Continuous works can make you tired, irritated and stressed. So take a break of 5 or 10 minutes between works.

During your break time listen to music, communicate with friends or family, do whatever you like or take a snack break.

Taking a short break can relax your mind and boost your interest.

Sunday, September 27, 2020

Why Pulse Oximeter is Important and Why Pulse Oximeter is Used?


Pulse Oximeter, oxygen saturation, SpO2, Why Pulse Oximeter is important
Image Source - Pixabay   

Oxygen is an essential component to maintain physiological functions in our body. In the human body, oxygen is carried by haemoglobin which is present in the blood. But in some cases normal oxygen level in the blood gets decreased which leads to hypoxemia (low oxygen level in the blood).

The amount of oxygen carried by the haemoglobin in the blood is known as oxygen saturation which also termed as SpO2. SpO2 indicates the percentage of oxygen present in the haemoglobin. So, it is very important to measure the oxygen level in some critical health issues or to maintain a healthy lifestyle. A pulse oximeter is a device used to measure the oxygen saturation level in the blood.

1. What is a pulse oximeter?

A pulse oximeter is an electronic device which used to measure oxygen saturation in the blood.

   • Pulse oximeter device clip onto a finger and passes light through blood of the finger and measures the oxygen level. Measuring oxygen saturation (SpO2) by a pulse oximeter device is a non-invasive procedure.

   • The normal oxygen saturation (SpO2)  range of a healthy adult man is between 95% to 100%

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2. Why Pulse Oximeter is Used?

The main purpose of the pulse oximeter device is to measure the oxygen level in the blood. For a healthy individual, definitely, the oxygen level will be normal, but in some cases and disease conditions oxygen level decrease which leads to disturbed physiological functions.

There are some conditions which mostly affect the blood oxygen levels. Actually, these conditions restrict the oxygen from getting saturated in the blood that means haemoglobin of the blood cannot hold the oxygen and cannot bind with it. These types of conditions are mentioned below -

   • Anemia

   • Asthma

   • Pneumonia

   • Lung cancer

   • COPD (Chronic obstructive pulmonary disease)

   • Congenital heart defects

   • Heart failure or heart attack

In such conditions immediate assessment, diagnosis and action are required. 

Pulse oximeter device can be used for various conditions but it has some common uses which mentioned below -

   • Pulse oximeter device is used to measure how the blood oxygen level is decreasing or increasing during some conditions or treatments.

   • It is used to determine that supplemental oxygen therapy is necessary or not for the client.

   • It determines how the supplemental oxygen therapy effective to increase the blood oxygen level.

   • Pulse oximeter is very important during and after the surgical procedures. It is used to monitor the oxygen level during procedures and recovery period.

   • It also assesses how ventilator is helpful for the client.

   • It helps to assess the ability of a client's physical activity.

   • It assesses how a medication works for the respiratory system.

3. How Pulse Oximeter Works?

A pulse oximeter is a clamp-like electronic device which is placed onto a finger, earlobe or toe.

NOTE - It has one processor and two LEDs. One is a red LED and another is an infra-red LED.

   • During the reading of a pulse oximeter, small rays of light from LEDs pass through the blood of finger, earlobe or toe.

   • When the light passes through the blood, the processor of the device measures the changes of the light which absorbed by the oxygenated blood or deoxygenated blood.

   • By measuring the changes of light, pulse oximeter determines the oxygen saturation (SpO2) level of your blood.

4. Why Pulse Oximeter is Important?

Pulse Oximeter, oxygen saturation, SpO2, Why Pulse Oximeter is important
Image Source - Pixabay   

We cannot live without oxygen and maintaining normal oxygen level is necessary for each and every healthy individual.

But in some cases and disease conditions disturb the normal oxygen saturation level in your body. If oxygen saturation decrease, this condition alter your normal physiology functions which lead to critical situations even death.

In that situation, measuring the current oxygen level is very important to continue the treatment. A pulse oximeter is a device used to measure the oxygen saturation level in such a critical situation.

Not only it is used for the disease conditions but also important during and after the surgical procedures. Pulse oximeter determines the oxygen level in the blood and according to the device reports health care professional can give ventilator support.

We cannot ignore the altered oxygen saturation level of a client because it can lead to severe conditions and even death. So, the importance of a pulse oximeter device can be considered as a lifesaver.

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5. What Can Prevent a Pulse Oximeter Reading Accurately?

   • Nail varnish or pigment on the finger

   • Bright light on the probe

   • Patient movement

   • Poor perfusion

   • Carbon monoxide poisoning

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Sunday, September 06, 2020

Administration of Injection - Principles, Techniques and Nurse's Responsibilities

Administration of Injection - Principles, Techniques and Nurse's Responsibilities
Image Source - Pixabay  


1. For the safe administration of the injection, the knowledge of anatomy and physiology of the human body is very essential.

   a. To avoid the injury of blood vessels and nerves of the underlying tissues.

   • Action - Select the injection site carefully by considering the anatomical structures.

NOTE - Common Sites for the Injection Administration

* ID (Intradermal) Injection Sites

   - The inner side of the lower arm.

   - The upper surface of the front chest.

   - The upper surface of the posterior chest, below the scapula.

* SC (Subcutaneous) Injection Sites -

   - The outer side of the upper arm.

   - The upper side of the posterior chest, below the scapula.

   - The anterior aspect of the abdomen, from the end of the ribs to iliac crest except for the navel area at least 2 inches away.

   - Front area and lateral area of the mid-thigh.

* IM (Intramuscular) Injection Sites -

   - The deltoid muscle of the upper arm.

   - Upper outer quadrant area of buttocks (gluteal muscles)

   - The lateral portion of the thigh (vastus lateralis)

   - The front side of the thigh (rectus femoris)

* IV (Intravenous) Injection Sites -

   - Any palpable and visible veins are commonly used as the intravenous site.

   - The most suitable vein is the median cubital vein.


   - Avoid administration of injection from the medial aspect of the limbs because it may lead to nerve injuries.

   - Especially for the IM injections, slightly pull back the plunger to check the blood. If you found blood in the syringe, change the injection site immediately because it punctured the vein.

   b. To reduce the pain.

   • Action -

     - Administration of Injection to the surface area is more painful comparing to the muscles. So, except any contraindications, administration of Injection in the deep muscles reduce the pain and also absorb the medications very quickly.

     - The pressure of liquid medication during the injection administration produces pain to the injection site. So, administer a very small amount of medication in intradermal injection. For the subcutaneous injection up to 2 mL is safe. For the intramuscular injection up to 5 mL. For the intravenous injection, we can administer a very large amount of medications.

     - Reduce the flow of medication during the injection administration because of the high flow of medications induces pain to the injection site.

     - To reduce the pain of Injection administration, choose the injection sites where sensory nerves supplies are poor.

     - Choose the needle which is sharp to reduce pain. Blunt or damaged needle injure the injection site's tissues.

   c. To improve the absorption of medications.

   • Action -

     - To improve the fluid absorption, the needle of the injection must penetrate deeply if possible but carefully. The intramuscular injections have faster absorption comparing to the intradermal and subcutaneous injections because of the deeper penetration.

     - Massage to the injection site improves the absorption of the medication by stimulating the circulation. But avoid massage for the intramuscular injections because the medication can back up to the subcutaneous tissues.

     - Absorption is more for the water-soluble medicines and also for the medications which have the same osmotic pressure as blood. For example - isotonic solutions.

2. If avoid infection control measures, injections are functioning as a mode of infection transmission.

   • Action -

     - Before the injection administration check, syringe and needle must be new and properly sterilized.

     - The prescribed medication must be shield properly and ensure that vials, ampules and bottles have no leakage.

     - During the preparation, clean the skin area of the injection site with an alcohol swab or any other disinfectant because the skin is the common site for growing infections.

     - The nurse should maintain infection control measures by washing hands properly before and after the procedure.

     - The necessary for the procedure must be handle carefully by following the infection control measures and aseptic techniques.

3. Be cautious and aware of the medications which can change the blood components, it can be harmful to the patient.

   • Action -

     - The normal pH value of human blood is 7.4 which is slightly basic. If the normal pH level is altered such as pH level is more than 7.8 or less than 7, it can be harmful to the human. Therefore always be careful about medications and ensure that blood pH level will be in a limitation.

     - Frequently check for the vital signs if prescribed medication is related to sodium and potassium salts because these types of medications can change the blood Ph level easily.

     - Also, be careful about the osmotic pressure of the medication or fluid. It is safe to administer isotonic fluids because isotonic fluids have the same osmotic pressure as the blood. But for the hypotonic solutions which have less osmotic pressure comparing to the human blood, can lead to hemolysis. For the hypertonic solutions which have more osmotic pressure comparing to human blood, shrink the normal blood cells.

4. Unknown and fearful situations can produce anxiety for the client.

   • Action -

     - Before starting the procedure, explain the whole procedure to the client, so that the client gets confidence and become familiar with the procedure.

     - Keep in mind that fear and anxiety increases muscle tension which leads to painful injection administration. Therefore, explain the procedure, advice the client to become relax and maintain a comfortable position.

     - Hide needle and syringe from the client before giving injection because the sight of the needle and syringe can to fear and panic to the client.

     - Distract the client by starting a conversation with the client during the introduction of the needle to reduce the pain.

     - To avoid anxiousness of the client provides needed privacy, if necessary.

5. Injected medication can not be retrieved. Be aware before injection administration and ensure the availability of antidote.

   • Action -

     - During the preparation, make sure that the medications are prescribed by the physician.

     - Follow the five rights of medication administration during the procedure.

     - Always be sure that the ward or procedure room has enough lighting facilities.

Some common mistakes must be avoided -

   - Check for the test dose results to prevent allergic reactions.

   - Follow aseptic techniques to prevent infection transmission.

   - To avoid circulatory overload, regulate the flow of intravenous fluids.

   - Push back the plunger of the syringe and check for the blood. If there is a presence of blood, immediately change the injection site.

   - Follow the prescription and administer the correct dosage to the client to avoid overdosage of medication.

   - Always remove the air bubbles from the syringe to avoid air embolism.

   - To avoid nerve injuries, choose an appropriate site before the injection administration.

6. Proper planning and arrangements save time, equipment and workloads.

   • Action -

     - The nurse should have procedure knowledge, skills, past experiences and enough confidence.

     - Always be attentive and aware to avoid mistakes during the procedure.

     - Before and during the procedure, the nurse must provide psychological support.

     - Collect all the necessary equipment and arrange to avoid loss of time and interruption of the procedure.


1. Administer Injection if there is a written order of a doctor.

2. During the injection administration procedure, the transmission of infection is common. Therefore carefully handle equipment, medicine and administer injection by following the aseptic techniques.

3. Syringes and needles have variation based on the purposes. You should not mix it. Always use the appropriate one.

For example - Intradermal injection syringe and aspiration syringe cannot be the same.

4. Before selecting needles and syringes, you must check for its condition. Needles must be sharp and syringes must be airtight with any leakage.

5. If you are withdrawing medicine from a vial, change the needle after it because rubber cap of a vial may become blunt the needle.

6. Must follow the five rights of medication administration.

7. Always check the expiry date of medicine and don't use any medicine if outdated or expired. 

8. Check for test dose result if a medicine has chances for allergic reaction.

9. Before injection administration, remove all the air bubbles from the syringe to prevent air embolism.

10. Don't administer more than one injection at the same site especially for the insulin injections because it may lead to  Lipodystrophy (break down of fat).

11. During injection administration, insert the needle quickly and smoothly, inject the medicine slowly and withdraw needle smoothly and quickly to reduce pain.

12. Other than intravenous, always push back the plunger after inserting the needle and check for the blood. If blood is present, immediately withdraw the needle and change the site.


(Pre-procedure assessment)

1. Check the patient's history such as age, allergic sensitivity, medical diagnosis and purpose of the injection.

2. Check for the doctor's order for injection, medication, dosage, frequency and routes of administration.

3. For verification of patient, ask name, check bed number and other data.

4. Must check for the nurse's records and confirm the last injection administration timing.

5. If medication has a chance for an allergic reaction, the nurse should provide a test dose before the injection administration.

6. Check the injection site properly. If the site has discolouration, pain, itching, swelling, redness, lesions and abscess formation, the nurse should change the site.

7. Check for the client's previous experience, nervousness, fear and anxiety. If the client is anxious, provide psychological support.

8. Check for contraindications.

9. Check for the client's knowledge and explain the procedure before starting the procedure to avoid nervousness and irritation.