A nurse on a Medical-Surgical unit is preparing to administer an intramuscular injection to a client. Which of the following sites can the nurse use? (Select all that apply.).

Rectus Femoris.

Vastus Lateralis.

Dorsogluteal.

Lower abdomen.

Deltoid.

Answer and Explanation

Correct Answer : B,C,E

Choice A rationale:

The choice "Rectus Femoris" is not the correct answer. The rectus femoris is a muscle located in the thigh and is not a common site for intramuscular injections due to its location and proximity to important structures.

Choice B rationale:

The correct answer is "Vastus Lateralis." Choice B is the correct answer. The vastus lateralis muscle is located on the lateral aspect of the thigh and is a suitable site for intramuscular injections. It is often used in infants and young children or in adults who have limited deltoid muscle mass.

Choice C rationale:

The correct answer is "Dorsogluteal." Choice C is the correct answer. The dorsogluteal muscle, located in the buttocks, has historically been used for intramuscular injections. However, it's important to note that due to the proximity of the sciatic nerve and the potential for incorrect injection technique, this site is used less frequently now.

Choice D rationale:

The choice "Lower abdomen" is not the correct answer. The lower abdomen is not a recommended site for intramuscular injections due to the risk of injuring underlying structures and the potential for subcutaneous injection instead of intramuscular.

Choice E rationale:

The correct answer is "Deltoid." Choice E is the correct answer. The deltoid muscle, located in the upper arm, is commonly used for intramuscular injections, especially for vaccines and smaller medication volumes. However, it has a limited muscle mass and may not be suitable for larger injection volumes.

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Correct Answer is B

Explanation

Choice A rationale:

Keeping a promise to a client not to tell their family about their diagnosis is an example of fidelity, respecting confidentiality and maintaining trust. However, it does not directly reflect the ethical principle of beneficence, which focuses on actions that promote the patient's well-being and best interests.

Choice B rationale:

Providing therapeutic touch to a dying patient by holding their hand is an example of beneficence. This action demonstrates compassion, emotional support, and comfort to the patient in a critical and vulnerable time. It promotes the patient's well-being by addressing their emotional and psychological needs.

Choice C rationale:

Involving a client in making decisions about their care is an example of respecting their autonomy and practicing shared decision-making. While this action is important and aligns with the principle of autonomy, it is not a direct example of beneficence, which centers on actively doing good for the patient.

Choice D rationale:

Telling the truth about forgetting to perform a procedure for a client is an example of honesty and integrity, which are essential ethical principles in nursing. However, it does not directly relate to beneficence, which emphasizes actions that actively contribute to the patient's well-being and benefit.

A. Apply a moisture barrier ointment to the client's skin. B. Request a prescription for the insertion of an indwelling urinary catheter. C. Reposition the client every 8 hours to prevent skin breakdown. D. Check the client's skin every 8 hours for signs of breakdown.

Correct Answer is A

Explanation

Choice A rationale:

Applying a moisture barrier ointment helps protect the skin from the effects of moisture exposure due to urinary incontinence. Prolonged exposure to urine can lead to skin breakdown, irritation, and infection. A moisture barrier ointment creates a protective barrier, reducing the risk of skin damage.

Choice B rationale:

Requesting a prescription for an indwelling urinary catheter is not typically the first intervention to prevent skin breakdown in clients with urinary incontinence. Catheters carry their own set of risks, including infection, and should be considered after other interventions have been explored.

Choice C rationale:

Repositioning the client every 8 hours is important for preventing pressure ulcers but may not be sufficient to prevent skin breakdown due to urinary incontinence. Clients with urinary incontinence should be repositioned more frequently to address the effects of moisture.

Choice D rationale:

Checking the client's skin every 8 hours is an important step, but it alone may not effectively prevent skin breakdown. Incontinence-associated dermatitis can develop quickly, so it's essential to implement protective measures like using a moisture barrier ointment.

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A nurse on a Medical-Surgical unit is preparing to administer an intramuscular injection to a client. Which of the following sites can the nurse use? (Select all that apply.).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

A nurse is caring for a client who has urinary incontinence. Which of the following actions should the nurse implement to prevent the development of skin breakdown?

Correct Answer is A

Explanation

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