A nurse in an outpatient pediatric clinic is caring for a 5-year-old child. Select the 5 actions the nurse should plan to take when administering the prescribed immunization.

A. The area 7 cm below the scapula is not a recommended site for intramuscular injections in children. Using this site can lead to nerve or bone injury. For school-age children, the deltoid muscle is the preferred site due to muscle size, accessibility, and effectiveness of absorption. B. Proper positioning is essential for safety and comfort during vaccine administration. Having the child face sideways or sit upright allows the nurse to access the deltoid easily, maintain control over the procedure, and minimize the risk of muscle or nerve injury. Sideways positioning can also help the child feel less intimidated, reducing anxiety during the injection. C. Accurate identification of the deltoid muscle is essential. Visualizing the entire upper arm ensures the injection is delivered into muscle tissue rather than subcutaneous fat, optimizing absorption and reducing the risk of injury or injection-site complications. D. The deltoid is the recommended intramuscular site for children aged 3 years and older because it is well-developed enough for proper absorption and easily accessible. Proper site selection contributes to effective vaccine administration and decreased discomfort. E. Education ensures that the parent or guardian is informed about expected side effects, benefits of immunization, and the importance of completing the vaccine series. This communication supports informed consent, adherence, and safety, while helping caregivers identify and respond to adverse reactions appropriately. F. Distraction techniques such as talking, singing, using toys, or counting can reduce fear and anxiety, decrease the child’s perception of pain, and improve the overall experience. Comfort measures are particularly important for school-age children who may have anxiety about injections.