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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale for Choice A:
Mixing insulin detemir and insulin aspart in the same syringe is not recommended due to their differing physicochemical properties and potential for altered absorption and action profiles.
It's crucial to follow manufacturer guidelines, as mixing may lead to suboptimal glycemic control or unpredictable insulin activity.
Rationale for Choice B:
The order of mixing insulin detemir and insulin aspart, even if done incorrectly in the same syringe, would not significantly impact the overall contraindication of mixing them.
The primary concern remains the potential for altered pharmacodynamics and pharmacokinetics when these insulins are combined.
Rationale for Choice C:
Drawing up insulin aspart and insulin detemir in separate syringes is the correct procedure.
This approach ensures that each insulin maintains its intended action profile and absorption characteristics, leading to more predictable glycemic control.
It also aligns with best practices and guidelines for insulin administration.
Rationale for Choice D:
While drawing up insulin detemir first in a separate syringe is technically correct, it offers no specific advantage over drawing up insulin aspart first in a separate syringe.
The key principle is to avoid mixing the two insulins in the same syringe.
Correct Answer is A
Explanation
Choice A rationale:
Shearing force is the primary factor that contributes to the formation of pressure injuries when a patient's body slides downward. It occurs when two surfaces move in opposite directions, causing stress and strain on the tissues between them.
Compression of Tissues: When the patient's body slides downward, the skin and underlying tissues are compressed between the bony prominences (such as the sacrum or heels) and the surface of the bed. This compression restricts blood flow to the area, depriving the tissues of oxygen and nutrients.
Tissue Stretching and Tearing: As the body slides, the skin and underlying tissues are also stretched and pulled in opposite directions. This shearing force disrupts the normal alignment of cells and tissues, leading to microscopic tears and damage.
Impaired Blood Flow: Shearing force further compromises blood flow by stretching and compressing blood vessels. This reduces the delivery of oxygen and nutrients to the tissues, while also hindering the removal of waste products.
Tissue Damage and Necrosis: The combination of compression, stretching, and impaired blood flow leads to cell death and tissue necrosis. This is the hallmark of pressure injuries, which can range from superficial blisters to deep ulcers that extend into muscle and bone.
Factors that Increase Shearing Force: Certain factors can increase the risk of shearing force and pressure injury development, including:
Increased moisture (from sweat or incontinence) Decreased mobility
Poor skin integrity
Malnutrition
Friction from bedsheets
In conclusion, shearing force is the main factor that contributes to pressure injury formation when a patient's body slides downward. It disrupts blood flow, damages tissues, and can lead to significant wounds.
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