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) Remind the client of the importance of medication adherence.: While emphasizing medication adherence is important, it does not directly advocate for the client's needs related to self-care at home. It is more of a standard teaching point rather than a specific action to support the client's independence.
B) Tell the client to avoid places where there are large crowds of people.: Advising the client to avoid crowded places is a precaution to prevent infection, but it does not empower the client or help them maintain their self-care abilities. Advocacy involves supporting the client's choices and helping them navigate their circumstances.
C) Initiate a referral for the client to a home health agency.: This action demonstrates client advocacy by actively seeking resources that can provide the client with the support they need to manage their care at home. A home health agency can offer assistance with medication management, monitoring health status, and providing companionship, which aligns with the client's goal of self-care while living alone.
D) Instruct the client to avoid eating raw vegetables.: While this is a valid dietary recommendation for someone with a compromised immune system, it does not specifically advocate for the client’s self-care or independence. It is a preventive measure rather than a supportive action that empowers the client.
Correct Answer is D
Explanation
A) "It is normal to feel this way after a morning run.": While some fatigue can be expected after exercise, the client's symptoms of diaphoresis, palpitations, and exhaustion suggest that there may be an underlying issue related to their diabetes management, such as hypoglycemia. This response downplays the seriousness of their symptoms.
B) "It becomes easier when exercise is a routine.": While it is true that regular exercise can improve fitness and make physical activity feel easier over time, this response does not address the immediate concern of the client's current symptoms, which could indicate hypoglycemia.
C) "Were you careful to not have carbohydrates after the run?": This response suggests a misunderstanding of the client's needs. After exercise, especially for someone with type 1 diabetes, it is important to ensure adequate carbohydrate intake to prevent hypoglycemia. The client may need carbohydrates rather than avoiding them.
D) "Did you decrease your insulin intake before you exercised?": This is the most appropriate response. Clients with type 1 diabetes need to manage their insulin levels carefully, especially around exercise. If the client did not adjust their insulin dose or carbohydrate intake appropriately, they could be at risk for hypoglycemia, which explains their symptoms. This question encourages the client to reflect on their diabetes management in relation to their exercise.