A hospice nurse is caring for a client who has a fentanyl patch applied. The client appears restless and agitated. Which of the following actions should the nurse take?

A. Decreased jaundice: While spironolactone may indirectly improve liver function in clients with cirrhosis, its primary mechanism of action is to reduce fluid retention by inhibiting aldosterone, thereby decreasing sodium and water retention. Improvement in jaundice may occur over time as liver function improves, but it is not a direct indicator of spironolactone's effectiveness.

B. Decreased ascites: Spironolactone is commonly used to treat ascites, a common complication of cirrhosis resulting from fluid accumulation in the abdomen due to portal hypertension and hypoalbuminemia. The reduction of ascites indicates that spironolactone is effectively reducing fluid retention, a key therapeutic goal in clients with cirrhosis.

C. Increased energy: While improving fluid balance may indirectly contribute to increased energy levels by reducing the symptoms of fluid overload, increased energy is not a direct effect of spironolactone therapy. Other factors, such as improved liver function or nutritional status, may contribute to increased energy levels.

D. Increased appetite: Spironolactone is not typically associated with increasing appetite. While improving fluid balance may indirectly impact appetite by reducing symptoms of fluid overload such as abdominal distension or discomfort, increased appetite is not a primary therapeutic effect of spironolactone.

A. Using two separate syringes to mix the insulin is unnecessary and increases the risk of dosing errors and contamination. When preparing a mixture of short-acting insulin and NPH insulin, it's important to maintain sterility and accuracy. Utilizing separate syringes for each insulin type helps ensure that the correct doses are drawn from each vial and reduces the risk of accidentally mixing up the insulins.
B. Ensuring the NPH insulin is drawn into the syringe first is essential to prevent contamination of the NPH vial with short-acting insulin, which could affect its onset and duration of action. NPH insulin has a cloudy appearance due to its suspension, while short-acting insulin is clear. Drawing the NPH insulin first helps avoid introducing any short-acting insulin into the NPH vial, which could alter the suspension's consistency and affect its therapeutic effects.

C. Administering the insulin within 20 minutes of preparation is not specifically related to the mixing process and depends on the specific type of insulin being used. The timing of insulin administration after preparation depends on the specific characteristics of the insulins being mixed. While some insulin mixtures may need to be administered promptly after preparation to maintain their efficacy, the timeframe can vary based on factors such as insulin stability and compatibility.
D. Injecting air into the vial before withdrawing the short-acting insulin prevents a vacuum from forming in the vial, making it easier to withdraw the correct dose. When withdrawing medication from a vial, especially one with a rubber stopper, injecting air into the vial first displaces the volume of liquid that will be withdrawn. This action prevents the formation of a vacuum inside the vial, which could impede the withdrawal process by creating resistance against the syringe plunger