A nurse is preparing to administer 2.5 mL of medication intramuscularly to an adult client. Which of the following is the safest site for the nurse to use?
Ventrogluteal
Dorsogluteal
Vastus lateralis
Rectus femoris
The Correct Answer is A
A. Ventrogluteal: The ventrogluteal site is preferred for intramuscular injections in adults because it is well away from major nerves and blood vessels, can safely accommodate larger volumes (up to 3 mL), and has a thick muscle mass, reducing the risk of injury.
B. Dorsogluteal: The dorsogluteal site is associated with a higher risk of sciatic nerve injury and is less preferred for intramuscular injections, especially for larger volumes. Its use is generally discouraged in adults.
C. Vastus lateralis: The vastus lateralis is safe for intramuscular injections, particularly in infants and toddlers, and can accommodate moderate volumes. However, in adults, the ventrogluteal site is safer and more comfortable for larger injections.
D. Rectus femoris: The rectus femoris is rarely used for intramuscular injections in adults because it is less accessible, more painful, and carries a higher risk of injury to underlying structures. It is generally reserved for self-injection or special circumstances.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Cheddar cheese: Cheddar and other aged cheeses contain high levels of tyramine, which can precipitate a hypertensive crisis when consumed by clients taking MAOIs like phenelzine. Avoiding aged cheeses is critical to prevent severe cardiovascular complications.
B. Bananas: Fresh bananas contain low levels of tyramine and are generally safe to consume in moderation while taking MAOIs. Only overripe bananas with high tyramine content should be limited, but this is less of a concern than aged cheeses.
C. Chicken: Fresh chicken does not contain significant tyramine and is safe to include in the diet while taking phenelzine. Properly cooked and stored poultry does not pose a risk for hypertensive crisis.
D. Peanut butter: Peanut butter contains minimal tyramine and is considered safe for clients on MAOIs. Only improperly stored or aged peanut products might pose a slight risk, making it much less critical than avoiding aged cheeses.
Correct Answer is D
Explanation
A. Blood pressure 94/68 mm Hg: While slightly on the lower end for a 7-year-old, mild hypotension may not yet be present in severe dehydration because children often maintain blood pressure until significant fluid loss occurs. Blood pressure alone is not the earliest or most sensitive indicator of severe dehydration.
B. Urinary output 30 mL/hr: Normal urinary output for a child is approximately 1 mL/kg/hr. A child with severe dehydration typically has markedly reduced urine output (oliguria), so 30 mL/hr is still be within a low-normal range depending on the child’s weight
C. Respiratory rate 24/mn: This respiratory rate is within normal limits for a 7-year-old (approximately 18–25 breaths/min). It does not reflect compensation for dehydration or hypovolemia and is not a reliable indicator of severe fluid loss.
D. Heart rate 152/min: Tachycardia is an early and sensitive sign of hypovolemia in children. A heart rate of 152/min is significantly elevated for a 7-year-old, indicating compensatory mechanisms to maintain perfusion in response to severe dehydration.
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