A nurse is caring for a client. Select the 3 statements the nurse should make.

Enoxaparin is a low-molecular-weight heparin used for the prophylaxis and treatment of venous thromboembolism. It functions by potentiating antithrombin 3 to inhibit factor Xa and thrombin. This medication is administered via subcutaneous injection, typically into the anterolateral or posterolateral abdominal wall. Proper technique is vital to ensure therapeutic absorption and to minimize the risk of localized hematoma or tissue trauma at the site. Rationale: A. Pinching the skin during subcutaneous administration ensures that the medication is deposited into the adipose tissue layer rather than the underlying muscle. This technique helps lift the subcutaneous fat away from the muscle fascia, which is critical for the slow, consistent absorption of enoxaparin. It also decreases the risk of accidental intramuscular injection, which could lead to rapid absorption and increased bleeding. B. Prefilled syringes of enoxaparin are specifically manufactured with a small nitrogen air bubble that should not be expelled before administration. This air bubble serves to "seal" the medication into the subcutaneous tissue as the needle is withdrawn, preventing leakage into the needle track. Expelling this bubble can result in an incomplete dose and increases the likelihood of localized skin irritation or bruising. C. Enoxaparin should not be injected into the muscle, as intramuscular administration can cause significant pain and the formation of large hematomas due to the high vascularity of muscle tissue. The preferred site for self-administration is the abdomen, specifically the "love handle" area. Using the upper arm muscle would be clinically inappropriate and would deviate from the evidence-based standards for low-molecular-weight heparin delivery. D. Site rotation is a fundamental principle of subcutaneous therapy to prevent the development of lipodystrophy or localized tissue hardening. Repetitive injections in the exact same location can impair the absorption of the anticoagulant over the 2-week course. By alternating between different quadrants of the abdominal wall, the nurse ensures that the skin and underlying fat remain healthy and capable of absorbing the drug. E. Inserting the needle at a 90-degree angle is the standard procedure for subcutaneous injections when an adequate skin fold can be pinched. This vertical approach ensures that the needle tip reaches the deep subcutaneous layer where enoxaparin is best absorbed. Using a 90-degree angle provides a consistent depth of delivery, which is essential for maintaining the predictable pharmacokinetic profile of this specific anticoagulant medication. F. The client must be explicitly instructed not to rub or massage the site following the injection of enoxaparin. Rubbing the area can cause mechanical trauma to the microvasculature that has already been sensitized by the anticoagulant, leading to significant ecchymosis and hematoma formation. Maintaining gentle pressure without movement is the correct method to minimize localized bleeding without causing further tissue damage or discomfort.