A nurse is providing teaching for a client who has diabetes mellitus about the self-administration of insulin. The client has prescriptions for regular and NPH insulins. Which of the following statements by the client indicates an understanding of the teaching?
"I will store prefilled syringes in the refrigerator with the needle pointed downward."
"I will shake the NPH vial vigorously before drawing up the insulin."
"I will insert the needle at a 15-degree angle."
"I will draw up the regular insulin into the syringe first."
The Correct Answer is D
A) "I will store prefilled syringes in the refrigerator with the needle pointed downward.": While prefilled syringes should be stored in the refrigerator, they should actually be stored with the needle pointing upward. This prevents the insulin from settling at the needle end and ensures that the insulin is readily available for injection. This statement reflects a misunderstanding of proper storage techniques.
B) "I will shake the NPH vial vigorously before drawing up the insulin.": NPH insulin should be gently rolled between the palms rather than shaken vigorously. Shaking can cause air bubbles and damage the insulin. This statement indicates a lack of understanding of the proper technique for preparing NPH insulin.
C) "I will insert the needle at a 15-degree angle.": The correct angle for injecting insulin is typically 90 degrees (or 45 degrees for thin clients), not 15 degrees. This statement shows a misunderstanding of proper injection technique.
D) "I will draw up the regular insulin into the syringe first.": This statement indicates an understanding of the proper technique for mixing insulins. When using both regular and NPH insulins, the regular insulin should always be drawn up first to prevent contamination of the short-acting insulin with the longer-acting insulin. This response reflects correct knowledge regarding insulin administration.
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Correct Answer is C
Explanation
A) Blistering at the site: Blistering is typically associated with partial-thickness burns rather than full-thickness burns. Full-thickness burns destroy both the epidermis and dermis, which usually do not present with blisters.
B) Epithelialization at the site: Epithelialization is a healing process that occurs after the burn site begins to heal. Since this client has sustained major full-thickness burns only 12 hours ago, epithelialization is not expected at this early stage.
C) Edema at the site: Edema is expected in the early stages following a major burn injury due to the inflammatory response and fluid shift that occurs. This finding aligns with the body's response to trauma and is common within the first 24 hours after a burn.
D) Severe pain at the site: Full-thickness burns typically have less pain at the site compared to partial-thickness burns because the nerve endings in the skin are destroyed. While there may be pain in surrounding areas or in partial-thickness areas, the full-thickness burn itself is often painless.
Correct Answer is A
Explanation
A) "Floss your teeth gently following each meal.": This instruction is appropriate for a client with mucositis. Gentle flossing can help maintain oral hygiene and reduce the risk of infection without causing additional trauma to the already sensitive mucous membranes. It's important to emphasize a gentle approach to minimize discomfort.
B) "Rinse your mouth with hydrogen peroxide.": Rinsing with hydrogen peroxide is not recommended for clients with mucositis, as it can be irritating to the mucous membranes and exacerbate discomfort. Alternatives such as saline or baking soda rinses are typically suggested instead.
C) "Wear your dentures only during meals.": While this may seem practical, clients with mucositis are often advised to avoid dentures altogether if possible, as they can irritate the mucosa. Instead, they should be encouraged to keep their mouth clean and free of irritants.
D) "Brush your teeth for 60 seconds twice daily.": Although maintaining oral hygiene is important, brushing for only 60 seconds may not be sufficient to ensure proper cleaning, especially in the presence of mucositis. It may also be painful, leading to avoidance. A gentler and more thorough approach is often advised, using a soft-bristled toothbrush.