The correct angle for an intramuscular (IM) injection is:

90 degrees. Intramuscular (IM) injections are given at a 90-degree angle (perpendicular to the skin) to ensure the medication reaches the muscle tissue. Intradermal (ID) injections are given at 10-15 degrees, and subcutaneous (SubQ) injections are given at 45 degrees (or 90 degrees with a short needle when pinching a skin fold).

Which injection site is preferred for intramuscular injections in infants and toddlers?

Vastus lateralis. The vastus lateralis (outer middle third of the thigh) is the preferred IM injection site for infants and toddlers because it is the most developed muscle in this age group. The deltoid is too small in infants. The ventrogluteal is an option for older toddlers but vastus lateralis remains preferred. The dorsogluteal is rarely used in any age group due to proximity to the sciatic nerve.

According to the DEA drug schedules, which schedule has the HIGHEST abuse potential and NO accepted medical use?

Schedule I. Schedule I substances have the highest abuse potential and no currently accepted medical use in the United States (e.g., heroin, LSD, ecstasy). Schedule II drugs also have high abuse potential but have accepted medical uses with severe restrictions (e.g., oxycodone, fentanyl, morphine). Schedules III through V have progressively lower abuse potential.

A medical assistant is preparing to administer a medication. How many times should the label be checked?

3 times. Medication labels should be checked THREE times: (1) when removing from storage, (2) when preparing the dose, and (3) when returning to storage or just before administering to the patient. This triple-check system is a critical safety measure that helps prevent medication errors, which are among the most common and preventable adverse events in healthcare.

The Z-track technique is used for IM injections that:

Are irritating to subcutaneous tissue or stain the skin. The Z-track technique displaces skin and subcutaneous tissue laterally before injection, creating a zigzag path that prevents medication from leaking back through the injection tract. It is used for medications that irritate subcutaneous tissue or stain the skin, such as iron dextran and hydroxyzine. The technique seals the medication deep in the muscle and prevents tracking through superficial tissues.

Key Takeaways

The "rights" of medication administration: right patient, right drug, right dose, right route, right time, right documentation, right to refuse
Injection angles: intradermal (ID) 10-15 degrees, subcutaneous (SubQ) 45 degrees, intramuscular (IM) 90 degrees
Common IM injection sites: vastus lateralis (infants/toddlers preferred), deltoid (adults, <1 mL), ventrogluteal (adults, up to 3 mL), dorsogluteal (rarely used due to sciatic nerve risk)
Medications are classified by their chemical, generic, and trade (brand) names
Drug schedules range from Schedule I (highest abuse potential, no medical use) to Schedule V (lowest abuse potential)
Common drug side effects, interactions, and contraindications are frequently tested on the RMA exam
Prescription abbreviations (PO, IM, IV, SubQ, PRN, BID, TID, QID) are essential knowledge
Pediatric dosages are typically calculated based on body weight (mg/kg) or body surface area
The Z-track technique is used for IM injections of medications that stain or irritate tissues (e.g., iron dextran)

Pharmacology & Medication Administration

Pharmacology is one of the most heavily tested topics within the Clinical Patient Interaction domain. Medical assistants must understand medication classifications, administration routes, injection techniques, and drug safety.

The "Rights" of Medication Administration

Every medication administered must meet these safety checks:

Right Patient -- Verify using two identifiers (name + DOB)
Right Drug -- Compare medication label to physician's order THREE times
Right Dose -- Verify the correct amount is being administered
Right Route -- Confirm the correct route (PO, IM, SubQ, IV, etc.)
Right Time -- Administer at the correct time/frequency
Right Documentation -- Record the administration immediately after giving
Right to Refuse -- Patients have the right to decline medication (document refusal)

Three-Point Medication Label Check

Check the medication label at THREE points:

When removing from storage
When preparing the dose
When returning to storage (or before administering to patient)

Medication Names

Name Type	Description	Example
Chemical name	Chemical structure of the drug	Acetylsalicylic acid
Generic name	Official, non-proprietary name (lowercase)	aspirin
Trade/brand name	Manufacturer's proprietary name (capitalized)	Bayer, Bufferin

Drug Schedules (DEA Controlled Substances)

Schedule	Abuse Potential	Medical Use	Examples
Schedule I	Highest	No accepted medical use in the U.S.	Heroin, LSD, marijuana (federal), ecstasy
Schedule II	High	Accepted with severe restrictions	Oxycodone, fentanyl, morphine, methylphenidate, amphetamine
Schedule III	Moderate	Accepted medical use	Testosterone, codeine combinations, ketamine
Schedule IV	Lower	Accepted medical use	Benzodiazepines (diazepam, alprazolam), tramadol, zolpidem
Schedule V	Lowest	Accepted medical use	Cough syrups with small amounts of codeine, pregabalin

Routes of Administration

Route	Abbreviation	Description
Oral	PO	By mouth; most common route
Sublingual	SL	Under the tongue (dissolves and absorbs)
Buccal	--	Between cheek and gum
Topical	TOP	Applied to skin surface
Transdermal	TD	Patch absorbed through skin
Inhalation	INH	Breathed into lungs
Intradermal	ID	Into the dermis layer of skin
Subcutaneous	SubQ / SC	Into subcutaneous fat tissue
Intramuscular	IM	Into muscle tissue
Intravenous	IV	Into a vein (fastest systemic route)
Rectal	PR	Into the rectum
Vaginal	PV	Into the vagina
Ophthalmic	--	Into the eye
Otic	--	Into the ear

Injection Techniques

Injection Angles, Needle Sizes, and Sites

Route	Angle	Needle Gauge	Needle Length	Volume	Common Sites
Intradermal (ID)	10-15°	25-27 gauge	3/8 - 5/8 inch	0.01-0.1 mL	Inner forearm, upper back
Subcutaneous (SubQ)	45° (or 90° if pinching skin fold)	23-25 gauge	1/2 - 5/8 inch	0.5-1.0 mL	Upper arm, abdomen, anterior thigh
Intramuscular (IM)	90°	20-23 gauge	1 - 1.5 inch	0.5-3.0 mL (adults)	Deltoid, vastus lateralis, ventrogluteal

IM Injection Sites

Site	Location	Maximum Volume	Notes
Deltoid	Upper arm, 2-3 finger widths below acromion process	1 mL (adults)	Most common for adult vaccines
Vastus lateralis	Outer middle third of the thigh	1 mL (infants), 2 mL (adults)	Preferred site for infants and toddlers
Ventrogluteal	Hip area (gluteus medius)	3 mL (adults)	Safest large-volume IM site; no major nerves
Dorsogluteal	Upper outer quadrant of buttock	3 mL (adults)	Rarely used due to sciatic nerve and blood vessel proximity

Z-Track Technique

Used for medications that are irritating to subcutaneous tissue or that stain the skin (e.g., iron dextran, hydroxyzine):

Select the ventrogluteal or vastus lateralis site
Pull the skin and subcutaneous tissue laterally (to the side) about 1-1.5 inches
Insert needle at 90 degrees while maintaining displacement
Aspirate (if required by facility policy) and inject medication slowly
Wait 10 seconds before removing the needle
Release the displaced tissue -- this creates a "zigzag" path that prevents medication from leaking back through the injection track

Common Medications by Category

Category	Examples	Use
Antibiotics	Amoxicillin, azithromycin, ciprofloxacin, doxycycline	Bacterial infections
Analgesics	Acetaminophen (Tylenol), ibuprofen (Advil), oxycodone	Pain relief
Antihypertensives	Lisinopril, metoprolol, amlodipine, losartan	High blood pressure
Antidiabetics	Metformin, insulin, glipizide	Diabetes management
Statins	Atorvastatin (Lipitor), simvastatin (Zocor)	High cholesterol
Anticoagulants	Warfarin (Coumadin), heparin, enoxaparin (Lovenox)	Blood clot prevention
Bronchodilators	Albuterol (ProAir), ipratropium	Asthma, COPD
Proton pump inhibitors	Omeprazole (Prilosec), pantoprazole (Protonix)	GERD, ulcers
Antidepressants	Sertraline (Zoloft), fluoxetine (Prozac), escitalopram (Lexapro)	Depression, anxiety
Thyroid medications	Levothyroxine (Synthroid)	Hypothyroidism

RMA Registered Medical Assistant Exam

1Introduction: RMA (AMT) Exam Overview

2Chapter 1: Anatomy & Physiology (20.9%)

3Chapter 2: Administrative Medical Assisting (26.7%)

4Chapter 3: Clinical Procedural Tasks (18.6%)

5Chapter 4: Clinical Patient Interaction (33.8%)

6Chapter 5: Exam Strategy & Practice