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 A
Explanation
A) Assess urine output hourly. Monitoring urine output hourly is critical in the postoperative care of a client following a kidney transplant. It helps assess kidney function and detect any potential complications such as acute rejection or acute tubular necrosis early. Changes in urine output can provide important information about the client's fluid status and renal perfusion.
B) Check the client's blood pressure every 8 hr. While monitoring blood pressure is important, it is not sufficient to check it only every 8 hours in the immediate postoperative period. Blood pressure can fluctuate significantly due to factors such as fluid status, medication effects, and potential complications. More frequent monitoring, especially in the first 24 hours, is essential for timely intervention.
C) Monitor for hypokalemia as a manifestation of acute rejection. Hypokalemia is not typically a manifestation of acute rejection following a kidney transplant; rather, hyperkalemia is more commonly observed due to impaired kidney function. Therefore, focusing on monitoring for signs of hyperkalemia would be more relevant in this context.
D) Administer opioids PO. While pain management is crucial after surgery, opioids are often administered intravenously in the immediate postoperative period for better control and quicker action. Oral administration may be appropriate later when the client is stable and can tolerate oral medications.
Correct Answer is D
Explanation
A) A client who has a headache following a grade 1 concussion: While this client may need monitoring, they are likely stable and do not require constant observation. Therefore, their placement can be further from the nurses' station.
B) A client who has experienced brain death and is awaiting organ procurement: This client may require occasional monitoring, but their condition is stable and less critical in terms of immediate nursing observation compared to those with fluctuating neurological statuses.
C) A client who has a score of 0 on the NIH Stroke Scale following a transient ischemic attack: A score of 0 indicates no neurological deficits at the time of assessment. This client is stable and does not necessarily require close observation.
D) A client who has a score of 10 on the Glasgow Coma Scale following a motor vehicle crash: A score of 10 indicates altered consciousness and potential risk for deterioration. This client requires closer monitoring and immediate access to nursing care, making it appropriate to assign them to a room closest to the nurses' station.