A nurse is caring for a client who has autism spectrum disorder. Which of the following findings should the nurse expect?

A. Place the infant in an infant seat for 2 hours following the procedure. There is no specific need to place the infant in an infant seat for 2 hours following a lumbar puncture. After the procedure, the infant should be positioned comfortably and safely, but there is no requirement for a specific duration in an infant seat.

B. Hold the infant's chin to his chest and knees to his abdomen during the procedure. This positioning is not appropriate for a lumbar puncture. The correct positioning for a lumbar puncture involves having the infant in a lateral recumbent (side-lying) position with knees flexed up toward the chest, allowing the spine to be flexed and creating space between the vertebrae for the needle insertion.

C. Keep the infant NPO for 6 hours prior to the procedure. Keeping the infant NPO (nothing by mouth) for 6 hours prior to the procedure is not necessary for a lumbar puncture. Infants can continue breastfeeding or formula feeding as usual before the procedure. However, if sedation or anesthesia is planned for the procedure, specific fasting guidelines may apply depending on institutional protocols and the infant's age and health status.

D. Apply a eutectic mixture of lidocaine and prilocaine cream topically 15 minutes prior to the procedure. This is the correct choice. Applying a eutectic mixture of lidocaine and prilocaine cream topically before the procedure helps to numb the skin and reduce pain at the site of the lumbar puncture. It is a standard practice to minimize discomfort for the infant during the procedure.

A. Use a 1.8 mm (0.5 in) needle:

Rationale: Needle length is typically not measured in millimeters for intramuscular injections. The length of the needle for intramuscular injections in preschoolers is usually longer, ranging from 16 to 25 mm (5/8 to 1 inch), depending on factors such as the child's size and the thickness of adipose tissue at the injection site.

B. Use a 20-gauge needle:

Rationale: While the gauge of the needle is important for controlling the flow rate of the medication, the size of the gauge alone does not determine the appropriateness of the needle for administering a vaccine into the deltoid muscle of a preschooler. The gauge of the needle commonly used for intramuscular injections in children is typically between 22 and 25 gauge.

C. Insert the needle at a 15-degree angle:

Rationale: When administering an intramuscular injection into the deltoid muscle, the needle should be inserted at a 90-degree angle (perpendicular to the skin) for children and adults. Using a 15-degree angle would result in a subcutaneous injection rather than reaching the muscle tissue.

D. Insert the needle just below the acromion process:

This is the correct action. When administering a vaccine into the deltoid muscle of a preschooler, the nurse should insert the needle just below the acromion process. This landmark helps ensure accurate placement of the needle into the deltoid muscle, which is the recommended site for intramuscular injections in preschool-age children.