A nurse in a community clinic is caring for a client who has erythema migrans. The nurse should implement which of the following precautions?

Rationale:

A. Place a pillow under the client's knees when changing positions: Elevating the knees with a pillow may be appropriate for comfort, but in a client with a thoracic spine injury, this can alter spinal alignment and increase the risk of further injury. Maintaining proper spinal alignment during all movements is more important than knee elevation.

B. Use a sheet when repositioning the client onto his side: Using a sheet for logrolling or turning helps maintain spinal alignment and allows multiple caregivers to move the client safely as a unit. This technique minimizes rotation or flexion of the spine, which is critical in preventing further spinal cord injury in clients with thoracic spine trauma.

C. Apply an immobilizing collar on the client prior to movement: Cervical collars are used for cervical spine injuries, not thoracic spine injuries. Applying a collar would not stabilize the thoracic spine and could give a false sense of security while performing repositioning.

D. Instruct the client to keep his arms at his side when altering positions: The client may need to assist in turning if possible, and keeping the arms rigidly at the side is not necessary. Restricting arm movement does not ensure spinal safety and may limit the client’s ability to participate safely in repositioning.

Rationale:

A. Administer the medication into the vastus lateralis muscle: The vastus lateralis is the preferred site for intramuscular injections in infants because it is well-developed and free of major nerves and blood vessels. This site allows for safe and effective absorption of the medication.

B. Administer the medication with a 20-gauge needle: A 20-gauge needle is too large for infants and can cause unnecessary tissue trauma. A smaller gauge, typically 22–25, is appropriate for IM injections in infants to minimize pain and tissue damage.

C. Administer the medication into the deltoid muscle: The deltoid muscle is underdeveloped in infants, making it unsuitable for IM injections due to limited muscle mass and risk of injury to underlying structures. It is generally used only in older children or adults.

D. Administer the medication over 2 min: IM injections are typically administered at a moderate pace, but a 2-minute administration is unnecessarily slow for infants. Proper technique involves steady, controlled injection without causing excessive discomfort.