NORCET 3 - 2022 (Shift-1)
Child Health Nursing (Pediatrics)
Easy
In child, Intra-osseous injection should administer in?
Appeared in: NORCET 3 - 2022 (Shift-1)
Explanation
- The term 'intraosseous' literally means 'within the bone'.
- The target for an intraosseous injection is the medullary cavity of a long bone, which contains the highly vascular bone marrow.
- The bone marrow provides a non-collapsible entry point to the systemic circulation, making it ideal for rapid administration of fluids and medications in emergencies when peripheral veins have collapsed.
- Almost any medication or fluid that can be given intravenously (IV) can also be administered via the IO route.
Why Other Options Were Wrong
- Option B: The spinal cord is part of the central nervous system. Injections here are termed 'intrathecal' or 'epidural' and are used for anesthesia or specific drug delivery to the CNS, not for systemic circulation access.
- Option C: A vein is the site for an intravenous (IV) injection. Intraosseous access is specifically chosen as an alternative when establishing IV access is difficult or has failed, particularly in an emergency.
- Option D: The endotracheal route involves administering aerosolized medication into the lungs via an endotracheal tube. While used in some emergencies (e.g., for epinephrine), it provides less reliable absorption than IO or IV routes and is not an injection.
Related Visual
- Visual 1: Anatomical Diagram - An illustration showing the common pediatric IO insertion sites, including the proximal tibia, distal femur, and distal tibia, with clear landmarks like the tibial tuberosity and medial malleolus.
- Visual 2: Procedure Illustration - A diagram showing the correct angle and technique for inserting an IO needle into the proximal tibia, highlighting the needle passing through the cortex into the marrow cavity.
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Intraosseous (IO) access in pediatrics as background academic context rather than a clinical decision trigger.
- IO access is a critical, life-saving skill in pediatric emergency medicine, particularly during resuscitation for shock, trauma, or cardiac arrest.
- Nurses must continuously monitor an IO site for complications such as extravasation (fluid leaking into tissues), compartment syndrome (dangerous pressure buildup), fractures, and osteomyelitis (bone infection).
- IO access is a temporary measure. It should be replaced with a definitive vascular access line (e.g., peripheral IV or central line) as soon as the patient is stabilized, typically within 24 hours.
How to Approach the Question
- First, analyze the key term in the question: 'Intra-osseous'. Break it down into its roots: 'Intra-' means 'within' and 'osseous' relates to 'bone'.
- This initial analysis tells you the injection must go into a bone structure.
- Next, evaluate the options based on this understanding. 'Bone marrow' is the soft, vascular tissue inside bones.
- Consider the other options. 'Spinal cord', 'Vein', and 'Endotracheal' represent different, distinct routes of administration (intrathecal, intravenous, and pulmonary, respectively).
- Eliminate the options that do not involve administration 'within the bone'. This leaves 'Bone marrow' as the only logical answer.
Concept Tested & Keywords
- Concept Tested: Intraosseous (IO) access in pediatrics
- Stem keywords: child, Intra-osseous injection, administer
- Lead-in keywords: in
- Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Question ID
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Practise the full NORCET 3 - 2022 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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