A nurse is preparing to administer the hepatitis B vaccine to a client. Which of the following techniques should the nurse use to locate the deltoid muscle?
Locate the middle third of the anterior thigh between the greater trochanter of the femur and the lateral femoral condyle.
Place one finger across the acromion process and measure 3 fingerbreadths below to the midpoint and center of the lateral aspect of the upper arm.
Find the center of the anterior aspect of the thigh.
Locate the center of the arm between the elbow and the shoulder.
The Correct Answer is B
B. This method is recommended because the deltoid muscle is a large, rounded, triangular muscle that covers the shoulder joint.
A. This description is for locating the vastus lateralis muscle, which is commonly used for intramuscular injections in infants and young children, not adults.
C. This technique is used for locating the rectus femoris muscle, another site for intramuscular injections in infants and young children, not adults.
D. This location is too low, which could miss the muscle tissue and reduce the effectiveness of the vaccine.
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Related Questions
Correct Answer is D
Explanation
D. Holding the skin taut helps stabilize the area and ensures that the needle penetrates the skin smoothly and at the correct angle. This also helps prevent the needle from going too deep or slipping out of the site during injection.
A. The syringe should be held at a 5 to 15-degree angle to the client's skin, not 20 degrees.
B. For a tuberculin skin test (PPD test), typically 0.1 mL (one-tenth of a milliliter) of PPD is injected intradermally. This is a very small amount compared to 0.5 mL.
C. The length of the needle for an intradermal injection is typically shorter than 1 inch, usually around 3/8 to 5/8 inches (10-16 mm). Using a longer needle may increase the risk of inserting the needle too deeply, potentially leading to subcutaneous rather than intradermal injection.
Correct Answer is ["A","D"]
Explanation
A. Diarrhea is a common side effect associated with ondansetron, which is used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and surgery.
B. Ondansetron can potentially cause changes in glucose metabolism, leading to hyperglycemia, especially in clients with diabetes mellitus. Monitoring blood glucose levels is essential during ondansetron administration, particularly in clients who are already predisposed to hyperglycemia.
D. Headache is a potential adverse effect of ondansetron. It is listed as a common side effect and should be monitored, especially in older adults who may be more sensitive to medication effects.
C. Ondansetron can affect the QT interval rather than the PR interval. It may cause QT interval prolongation, which can predispose the client to arrhythmias
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