If a nurse needs to administer 3 mL of medication intramuscularly to an adult patient, which site should be used for the injection?
Dorsal gluteal
Deltoid
Vastus lateralis
Lateral piriformis
The Correct Answer is C
Choice A rationale:
The dorsal gluteal site, also known as the dorsogluteal site, was once a common choice for intramuscular injections. However, it has fallen out of favor due to several concerns, including:
Risk of sciatic nerve injury: The sciatic nerve, the largest nerve in the body, runs deep within the gluteal region. Injections into the dorsal gluteal site have a higher risk of accidentally hitting this nerve, which can lead to pain, numbness, and weakness in the leg.
Difficulty in landmarking: Accurately locating the dorsal gluteal site can be challenging, especially in patients with excessive adipose tissue or those who are unable to position themselves properly. Incorrect injection placement can increase the risk of tissue damage and poor drug absorption.
Pain: The dorsal gluteal site is often more painful than other intramuscular injection sites, likely due to the presence of more nerve endings in the area.
Choice B rationale:
The deltoid muscle, located in the upper arm, is a common site for intramuscular injections, particularly for vaccines. However, it has limitations when it comes to administering larger volumes of medication:
Small muscle mass: The deltoid is a relatively small muscle, limiting the amount of medication that can be safely injected. It's generally recommended to inject no more than 1-2 mL of medication into the deltoid muscle.
Proximity to nerves and blood vessels: The deltoid muscle is located near the radial nerve and brachial artery. Improper injection technique could potentially injure these structures.
Choice C rationale:
The vastus lateralis muscle, located in the anterolateral aspect of the thigh, is considered the preferred site for intramuscular injections in adults when the volume of medication exceeds 2 mL. Here's why:
Large muscle mass: The vastus lateralis is a large, thick muscle, capable of accommodating larger volumes of medication (up to 5 mL).
Easy to access: The vastus lateralis is easily accessible and can be injected with the patient in a sitting or lying position.
Fewer nerves and blood vessels: The vastus lateralis has fewer major nerves and blood vessels compared to other injection sites, reducing the risk of injury.
Pain tolerance: Studies have shown that injections into the vastus lateralis are generally less painful than injections into the deltoid or gluteal muscles.
Choice D rationale:
The lateral piriformis muscle is not a recognized or recommended site for intramuscular injections. It's a deep muscle located within the pelvic region, making it difficult to access and posing a higher risk of injury to surrounding structures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Thick, creamy yellow discharge is a hallmark characteristic of purulent drainage. This type of drainage is commonly referred to as pus and is indicative of an infection within the wound. It is composed of white blood cells, dead bacteria, cellular debris, and inflammatory cells, giving it its characteristic opaque, thick, and yellowish appearance.
Purulent drainage is a significant clinical finding that requires prompt attention and intervention. Early identification and management of wound infections can prevent complications such as abscess formation, cellulitis, sepsis, and delayed wound healing.
Accurate documentation of purulent drainage is essential for communication among healthcare providers, monitoring wound progress, and guiding treatment decisions.
Choice B rationale:
Serosanguineous drainage is a mixture of serous fluid (clear, thin, and watery) and blood. It often appears pink or slightly red and is commonly observed in the early stages of wound healing or after dressing changes. While it may contain a small amount of blood, it lacks the thick, creamy consistency and yellow color that are characteristic of purulent drainage.
Choice C rationale:
Serous drainage is clear, thin, and watery, resembling plasma. It is a normal part of the wound healing process and is often seen in the early inflammatory stage. It does not contain the thick consistency or yellow coloration that are indicative of purulent drainage.
Choice D rationale:
Sanguineous drainage is composed primarily of fresh blood. It is bright red in color and typically indicates active bleeding within the wound. It does not exhibit the thick, creamy consistency or yellow hue that are characteristic of purulent drainage.
Correct Answer is C
Explanation
Choice A rationale:
Indurated describes tissue that is hardened and thickened, typically due to inflammation or fibrosis. While a decubitus ulcer with thick necrotic tissue may feel firm to the touch, induration does not accurately capture the extent of tissue damage and depth of the wound.
Indurated tissue often feels leathery or stiff, while necrotic tissue can be more varied in texture, ranging from dry and crusty to soft and sloughy.
Additionally, induration can occur in wounds that are not full-thickness ulcers, such as pressure injuries that have not yet progressed to the point of tissue loss.
Choice B rationale:
Fluctuant describes a fluid-filled cavity beneath the skin. While a decubitus ulcer with thick necrotic tissue may have some underlying fluid, it would not typically be described as fluctuant.
Fluctuance is more characteristic of abscesses or other fluid collections that have a distinct, palpable pocket of fluid.
The presence of thick necrotic tissue in a decubitus ulcer can obscure the presence of any underlying fluid, making it difficult to assess for fluctuance.
Choice D rationale:
Macerated describes skin that is softened and broken down due to prolonged exposure to moisture. While maceration can occur in the surrounding skin of a decubitus ulcer, it does not accurately describe the ulcer itself.
Maceration is typically seen in areas where skin folds rub together, such as the groin or armpits, and is often associated with incontinence or excessive sweating.
The presence of thick necrotic tissue in a decubitus ulcer indicates a more advanced stage of tissue damage that is not simply due to moisture exposure.
Choice C rationale:
Unstageable is the most accurate term to describe a decubitus ulcer with thick necrotic tissue because it indicates that the extent of tissue damage cannot be fully assessed.
Thick necrotic tissue obscures the base of the wound and the surrounding tissue, making it impossible to determine the depth of the ulcer or the extent of undermining.
This lack of visibility prevents accurate staging of the ulcer using the traditional pressure ulcer staging system, which categorizes ulcers based on their depth and extent of tissue involvement.
Therefore, unstageable is the most appropriate term to describe a decubitus ulcer with thick necrotic tissue.
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