0730

• Admit to the surgical floor
• Dextrose 59% and 0.9% sodium chloride to infuse at 125 ml/hr
• Advance diet as tolerated
• Insulin glargine 12 units subcutaneous every 12 hours
• Ceftriaxone 2 g IV every 24 hours for 3 days, first dose given in surgery
• Insulin lispro 1 unit subcutaneously per 15 carbohydrates
• Insulin lispro sliding scale:

180-240 mg/dL (10-13.3 mmol/L)- 1 unit

241-300 mg/dl. (13.4-16.7 mmol/L)-2 units

300-360 mg/dL (16.7-30 mmol/L)-3 units

over 360 mg/dL (30 mmol/L)-call the physician

• Glucagon 1 syringe subcutaneously for blood glucose less than 60 mg/dL (3.3 mmol/L) and unresponsiveness

It is 1800, and the client has a schedule dose of insulin glargine due. The client has a regular diet tray ordered with 60 carbohydrates. The tray has not yet arrived in the room.

For each nursing action below, click to specify If the action is indicated, contraindicated or non-essential.

B. Have you noticed the need to urinate less often? - Elevated serum creatinine and BUN levels can be indicative of decreased kidney function, which might result in decreased urine output.

D. Have you experienced urgency to urinate? - Abnormal electrolyte levels, such as high potassium (hyperkalemia), can affect bladder function and cause urinary urgency.

E. Are you taking any supplements? - High potassium levels can sometimes be related to potassium-containing supplements, so it's essential to inquire about any supplements the client may be taking.

F. Do you use any salt substitutes? - High potassium levels can be caused by the excessive use of salt substitutes, which often contain potassium chloride.

A. Have you experienced itching or hives? - While itching or hives can be associated with various conditions, these symptoms may not be directly related to the specific lab results mentioned.

C. Have you noticed that your skin is dry? - Dry skin is a non-specific symptom and may not be directly related to these lab results.

A. Consulting with a pharmacist about scheduling the dose one hour after the client eats:

While it is important to take risedronate on an empty stomach, waiting one hour after eating is insufficient. The recommendation is to take it first thing in the morning, at least 30 minutes before any other food or drink, including milk.

B. Withholding the medication until the client's breakfast tray is available on the unit:

Delaying the administration of risedronate until breakfast may not align with the recommended dosing instructions, which specify taking it in the morning on an empty stomach. Delaying the medication could affect its effectiveness.

C. Assigning unlicensed assistive personnel (UAP) to bring the client a glass of low-fat milk:

Providing milk or other beverages with risedronate is not appropriate, as it can interfere with the medication's absorption. Instructing the client to take it with water alone is the correct approach.

The correct action for the nurse to take when the client with osteoporosis asks for a glass of milk to drink with risedronate is:

D. Instruct the client that it is necessary to take nothing but water with the medication.

Explanation: Risedronate is a bisphosphonate medication used to treat osteoporosis. It is essential that it be taken with plain water (typically at least 6-8 ounces) on an empty stomach, preferably in the morning before any food, beverages, or other medications. Consuming other liquids, especially milk or calcium-containing beverages, can interfere with the absorption of the medication. Therefore, instructing the client to take risedronate with water alone is the correct action to ensure its effectiveness.