A nurse is preparing to administer vitamin
K. Which of the following muscles should the nurse consider for the injection?
Deltoid
Vastus lateralis
Ventrogluteal
Dorsogluteal .
The Correct Answer is B
Choice A rationale
The deltoid muscle is not typically used for intramuscular injections in infants due to its small size.
Choice B rationale
The vastus lateralis muscle is one of the preferred sites for intramuscular injections in infants, including the vitamin K injection. This muscle is large enough to absorb the medication, and injections here carry less risk of hitting a nerve or blood vessel.
Choice C rationale
The ventrogluteal muscle is not typically used for intramuscular injections in infants. This site is often used in older children and adults.
Choice D rationale
The dorsogluteal site is not recommended for intramuscular injections due to the risk of damaging the sciatic nerve.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Administering oxytocic medication is an intervention that may be necessary if the client’s bleeding does not stop or if the uterus does not contract adequately. However, the priority is to assess the situation, which includes palpating the uterine fundus.
Choice B rationale
Assisting the client on a bedpan to urinate can help if the bladder is full and preventing the uterus from contracting properly. However, the priority is to assess the uterus by palpating the uterine fundus.
Choice C rationale
Palpating the client’s uterine fundus is the priority nursing intervention. A boggy uterus (one that does not contract properly) is a common cause of postpartum hemorrhage. If the uterus is not firm upon palpation, massage it until it firms up.
Choice D rationale
Increasing the client’s fluid intake can help replace lost fluids, but it is not the priority intervention. The first step is to assess the cause of the bleeding, which includes palpating the uterine fundus.
Correct Answer is B
Explanation
Choice A rationale
Administering oxygen via a nasal cannula is not the appropriate response to a client experiencing tingling fingers during pattern-paced breathing. This symptom is not indicative of hypoxia.
Choice B rationale
Having the client tuck her chin to her chest can help alleviate the tingling sensation. This position can help reduce hyperventilation, which is often the cause of the tingling.
Choice C rationale
Assisting the client to breathe into a paper bag is not the appropriate response to a client experiencing tingling fingers during pattern-paced breathing. This action is typically used to treat hyperventilation, but it is not the first-line intervention.
Choice D rationale
Instructing the client to increase her respiratory rate to more than 42 breaths per minute is not the appropriate response to a client experiencing tingling fingers during pattern-paced breathing. This could exacerbate the problem by causing further hyperventilation.
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