DHS Staff Nurse - 2018 (Shift-2nd)
Child Health Nursing (Pediatrics)
Easy
Which of the following muscles would the nurse choose as the preferred site for a newborn's vitamin K injection?
Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)
Explanation
- The vastus lateralis is the largest and most well-developed muscle in a newborn, making it the ideal site for intramuscular injections.
- Its location on the anterolateral thigh is distant from major nerves (like the sciatic nerve) and blood vessels, ensuring the highest margin of safety.
- It is the universally recommended site by pediatric and nursing guidelines for administering medications like the Vitamin K shot and vaccines to infants.
Why Other Options Were Wrong
- Option A: The gluteal muscles, including the gluteus medius, are underdeveloped in newborns. Using this site carries a high risk of damaging the sciatic nerve, which can lead to permanent leg paralysis.
- Option B: The deltoid muscle in a newborn is extremely small and not developed enough to safely accommodate the volume of an IM injection. It can only hold very small volumes of medication.
- Option D: While the rectus femoris muscle can be used for IM injections in infants, it is not the preferred site because it is associated with more pain and discomfort upon injection compared to the vastus lateralis.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Intramuscular (IM) injection sites for newborns helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Correct site selection is a critical patient safety measure in neonates to prevent iatrogenic injury, such as nerve damage or hitting a bone, which can have lifelong consequences.
- All newborns in India receive a Vitamin K injection at birth as per national guidelines to prevent Vitamin K Deficiency Bleeding (VKDB), making this a fundamental nursing skill.
- What if? If a child is over 18 months old and has been walking for some time, the ventrogluteal site may become a viable option, but the vastus lateralis remains a primary site throughout early childhood.
How to Approach the Question
- This is a factual recall question based on a standard nursing procedure.
- First, identify the key elements in the question: 'newborn', 'injection', and 'preferred site'.
- Recall the principles of pediatric medication administration, focusing on the anatomical and developmental differences in infants.
- Remember that a newborn's muscles are not fully developed. The gluteal and deltoid muscles are particularly small and pose safety risks.
- This knowledge leads you to the thigh muscles. The vastus lateralis is taught as the largest, safest, and therefore preferred muscle for IM injections in this age group.
- Systematically eliminate the other options based on specific risks: gluteus medius (sciatic nerve), deltoid (small size), and rectus femoris (more painful).
Concept Tested & Keywords
- Concept Tested: Intramuscular (IM) injection sites for newborns
- Stem keywords: newborn, vitamin K injection, preferred site, muscle
- Lead-in keywords: preferred
- Clinical cues: Patient age (newborn) is the most critical factor for site selection.
- Negative lead-in flag: false
Question ID
Q97C1CDc3tuD9K7vBRNC0s
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 174-176
E6 Nursing Fundamentals Taylor p. 861-863
Practise the full DHS Staff Nurse - 2018 (Shift-2nd)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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