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) A client who has diabetes mellitus and is presenting with acute ketoacidosis: While this client requires careful monitoring and may need a private room if they are at risk for complications, they generally do not require isolation from other clients.
B) A client who has a compound fracture of the right femur: This client does not require a private room. Although they may need specific positioning and care, there are typically no infectious or isolation concerns.
C) A client who reports having fever, right sweats, and cough for 2 days: This client requires a private room due to the possibility of an infectious condition, such as pneumonia or tuberculosis. Symptoms like fever and cough, along with sweating, raise concerns about contagious diseases, making isolation necessary to protect other clients.
D) An older adult client who was admitted with aspiration pneumonia: While this client may need close monitoring, they do not automatically require a private room unless there are additional infection control concerns or if they are particularly contagious.
Correct Answer is A
Explanation
A) Decreased anxiety: Morphine is an opioid analgesic that not only alleviates pain but also has anxiolytic properties, helping to reduce anxiety and promote a sense of well-being. In the context of acute heart failure, clients often experience anxiety due to the sensation of breathlessness and overall distress. Therefore, a noticeable decrease in anxiety levels indicates that the morphine is providing therapeutic relief and contributing positively to the client's emotional state.
B) Emesis of 250 mL: While nausea and vomiting can occur with morphine administration, emesis is generally considered an adverse effect rather than an indication of the medication's effectiveness. In fact, significant vomiting can lead to further complications, such as dehydration or electrolyte imbalances, and may require intervention. Therefore, emesis does not reflect the intended therapeutic outcomes of morphine.
C) Increased respiratory rate to 26/min: An increased respiratory rate may signal distress or inadequate ventilation, which can be concerning in a client with acute heart failure. While morphine can cause respiratory depression in some cases, an elevated respiratory rate may indicate that the client is still experiencing discomfort or hypoxia, suggesting that the medication may not have been effective in alleviating their symptoms.
D) Decreased urinary output: Decreased urinary output can be a sign of renal impairment or fluid overload, which may be exacerbated by heart failure rather than an indication of morphine's effectiveness. In the setting of acute heart failure, monitoring urinary output is essential, but a reduction does not reflect the success of morphine therapy and may warrant further evaluation and intervention.