A nurse is planning to administer the influenza vaccine to a toddler. Which of the following actions should the nurse take?
Administer intramuscularly in the anterolateral thigh.
Divide the medication into two injections if necessary.
Use a 22-25 gauge needle.
Place the child in a comfortable position, preferably sitting upright.
The Correct Answer is A
Choice A reason: The anterolateral thigh is the recommended site for intramuscular injections in toddlers due to the well-developed muscles and minimal risk of injury to nerves or blood vessels.
Choice B reason: Dividing the medication into two injections may be necessary for large volumes, but influenza vaccines typically do not require this.
Choice C reason: A 22-25 gauge needle is recommended for intramuscular injections in toddlers to minimize discomfort and tissue damage.
Choice D reason: While the supine position is not incorrect, a comfortable sitting position is preferable for toddlers to reduce anxiety and ensure a smooth vaccination process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C"]
Explanation
Choice A reason: Increased urinary output is not typically associated with heart failure. In fact, reduced urinary output may be expected due to decreased kidney perfusion.
Choice B reason: Nasal flaring is a sign of respiratory distress and can be expected in infants with heart failure as they struggle to maintain oxygenation.
Choice C reason: Peripheral edema is a common finding in heart failure due to fluid retention and poor circulation.
Choice D reason: Bradycardia is not a typical sign of heart failure in infants; tachycardia is more common. However, bradycardia can occur in advanced stages due to poor cardiac output.
Choice E reason: Cool extremities are indicative of poor perfusion, which is a consequence of decreased cardiac output in heart failure.
Correct Answer is A
Explanation
Choice A reason: A sweat chloride content of 85 mEq/L is indicative of cystic fibrosis, as normal values are below 30 mEq/L, and values above 60 mEq/L are diagnostic for cystic fibrosis.
Choice B reason: Hard, packed stools could be a sign of cystic fibrosis but are not as diagnostic as a sweat chloride test.
Choice C reason: Increased blood levels of fat-soluble vitamins are not typically associated with cystic fibrosis; patients often have deficiencies due to malabsorption.
Choice D reason: A chest x-ray negative for atelectasis does not indicate cystic fibrosis, as atelectasis can be present in many conditions.
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