A nurse is planning to administer immunizations to a 2-month -old infant. Which of the following actions should the nurse take to decrease the infant pain.
apply a warm pack to the injection site prior to administration.
Ask the parent to leave the room during the injections.
Administer the injections in the deltoid muscle.
Administer the injections while the infant is breastfeeding?
The Correct Answer is D
Choice A rationale
Applying a warm pack to the injection site prior to administration is not recommended as it does not effectively reduce pain during immunizations.
Choice B rationale
Asking the parent to leave the room during the injections is not recommended as it may increase the infant’s anxiety and distress.
Choice C rationale
Administering the injections in the deltoid muscle is not recommended for a 2-month-old infant. The recommended site for intramuscular administration of immunizations in children under 18 months of age is the vastus lateralis (anterolateral thigh)3.
Choice D rationale
Administering the injections while the infant is breastfeeding is recommended. Breastfeeding during immunizations has been shown to significantly reduce pain and distress in infants.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Prolonged headache is not typically identified as a common trigger for seizures. While headaches can be associated with certain types of seizures, they are not generally considered a trigger for seizure activity.
Choice B rationale
Decreased temperature, or hypothermia, is not typically identified as a common trigger for seizures. In fact, fever or increased body temperature is more commonly associated with triggering seizures, particularly in children.
Choice C rationale
Lack of sleep is a well-recognized trigger for seizures. Sleep deprivation can lead to increased seizure frequency in individuals with epilepsy. Ensuring adequate sleep is an important part of managing seizure disorders.
Choice D rationale
Exposure to second-hand smoke is not typically identified as a common trigger for seizures. While it is generally harmful to health, it is not specifically associated with an increased risk of seizures.
Correct Answer is C
Explanation
The correct answer is Choice C.
Choice A rationale: A cooling blanket is typically used to manage hyperthermia in conditions like malignant hyperthermia, not routine postoperative recovery. It might cause the toddler to become too cold, leading to hypothermia or discomfort.
Choice B rationale: IV dantrolene sodium is administered for malignant hyperthermia, a rare but serious reaction to certain anesthesia medications. It is not appropriate for routine surgical recovery unless such a reaction is suspected or diagnosed.
Choice C rationale: Using an incentive spirometer encourages deep breathing, helping to prevent postoperative respiratory complications like atelectasis and pneumonia. It is an effective tool to promote lung expansion and improve oxygenation in the recovering toddler.
Choice D rationale: Administering aspirin to a toddler is not recommended due to the risk of Reye's syndrome, a serious condition causing swelling in the liver and brain. Alternative pain management strategies should be utilized for pediatric patients.
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