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Insert needle at a 45° angle to minimize pain:A 45° angle is used for subcutaneous injections, not intramuscular ones. IM injections, including the Z-track method, require a 90° angle to ensure the medication reaches deep muscle tissue, where it can be absorbed properly.

Inject medication slowly into subcutaneous tissue to prevent leakage:The Z-track technique is not used for subcutaneous injections. Injecting into subcutaneous tissue is inappropriate for medications that require deep muscle absorption, and leakage is more likely to occur if the medication is not placed intramuscularly.

Use a tuberculin syringe for small volumes and precise dosing:Tuberculin syringes are typically used for intradermal or very small subcutaneous injections, not for IM injections. The Z-track method requires a standard IM syringe and needle suitable for deep tissue penetration.

Deltoid, because it allows for higher volume administration:The deltoid site is commonly used for vaccinations, but it is limited to small-volume injections (usually ≤1 mL). It does not accommodate larger volumes well and carries a higher risk of injuring the radial nerve if not properly located.

Vastus lateralis, due to proximity to nerves:Although the vastus lateralis is safe for infants and children, this answer is misleading. Its proximity to nerves is a concern, not a benefit. It’s used when the ventrogluteal site is not suitable, but it is not the first choice for adults.

Rectus femoris, because it's easiest to access:While this muscle is accessible, particularly in self-administration or when other sites are contraindicated, it is not typically recommended due to discomfort and the potential for inconsistent absorption. It is not the safest or most preferred option for IM injections.

Aspirate after inserting the needle to confirm placement:Aspirating during a subcutaneous injection, especially with heparin, is not recommended because it may cause bruising and tissue damage. Heparin is a high-risk medication, and aspiration increases the chance of bleeding at the injection site.

Administer in the deltoid muscle:Heparin is not given intramuscularly due to the risk of hematoma formation. The deltoid is an intramuscular site, making it inappropriate for subcutaneous administration of anticoagulants like heparin.

Shake the heparin vial to ensure the drug is evenly distributed:Shaking heparin can damage the molecular structure of the drug and increase the risk of foaming or bubbles, which could alter dosage accuracy. Heparin should be gently rolled if mixing is necessary.

Deltoid:The deltoid muscle is underdeveloped in infants and is not recommended for IM injections until the child is older (typically over 18 months), due to its small size and limited capacity for medication volume.

Ventrogluteal:Although the ventrogluteal site is preferred in adults and older children because of its safety and distance from major nerves and vessels, it requires more muscle development than is present in a 3-month-old infant. It may be used in older infants if muscle mass is sufficient, but not at 3 months.

Dorsogluteal:This site should be avoided in infants and children due to the proximity to the sciatic nerve and major blood vessels, which poses a high risk of nerve injury or vascular complications.

Draw up cloudy first, then clear:This sequence risks contaminating the vial of short-acting insulin (clear) with intermediate-acting insulin (cloudy), altering its pharmacokinetics. Clear insulin must remain uncontaminated for precise glucose control.

Draw up air into both, then inject cloudy:Air should be injected into both vials, but the order matters. Air should be injected into the cloudy vial first (without drawing), then into the clear vial, followed by drawing up the clear insulin. This option omits essential steps and implies drawing up insulin in the wrong order.

Mix both in the vial before drawing up:
Mixing both types of insulin in the vial is never recommended. Each type has a distinct action and formulation, and combining them in a vial compromises the effectiveness and stability of the insulins