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 B
Explanation
A) Decorticate posturing: This is a more severe and late sign of increased intracranial pressure and indicates significant neurological impairment. It is not typically seen as an early manifestation.
B) Restlessness: Restlessness is often one of the earliest signs of increased intracranial pressure. It can indicate changes in consciousness and may be the first observable change in a client's behavior as ICP begins to rise.
C) Projectile vomiting: This is usually a later sign of increased ICP and may occur as pressure continues to increase. It suggests significant involvement of the brain and is not an early manifestation.
D) Papilledema: While papilledema (swelling of the optic nerve head) can occur with increased ICP, it often takes time to develop and is not an immediate or early sign. It typically appears after sustained elevated ICP levels.