A nurse is assessing a client's ability to swallow. Which of the following, when selected by the nurse, indicates an understanding of the cranial nerve that tests the ability to swallow?

a) Assess the client for side effects of carbamazepine:

• This option might seem reasonable as monitoring for side effects is essential with any medication, especially one with a narrow therapeutic range like carbamazepine. However, the client's level of 8.4 mcg/L is within the therapeutic range (4 to 12 mcg/mL), so there's no immediate indication that side effects are likely to occur solely based on this level.

b) Notify the healthcare provider of the carbamazepine level:

• While it's important to keep the healthcare provider informed about the client's condition, in this case, the carbamazepine level is within the therapeutic range. There's no urgent need to notify the provider unless there are other concerning factors not mentioned in the scenario.

c) Administer the carbamazepine as prescribed:

• This is the correct answer. The client's morning carbamazepine level of 8.4 mcg/L falls within the therapeutic range (4 to 12 mcg/mL). Therefore, the evening dose should be administered as prescribed to maintain therapeutic levels and control the client's condition.

d) Withhold this dose of the carbamazepine:

• Withholding the dose based solely on the morning carbamazepine level of 8.4 mcg/L, which is within the therapeutic range, would not be appropriate. Withholding the dose without consulting the healthcare provider could potentially lead to suboptimal management of the client's condition.

Choice A rationale: Indicated. This is important for a client with type 1 diabetes, as counting carbohydrates helps in calculating the appropriate insulin dose and maintaining glycemic control.

Choice B rationale: Non-essential. The client is already admitted to the surgical floor and does not require restarting the IV fluids unless there is a specific medical indication.

Choice C rationale: Contraindicated. Insulin doses should be prescribed by a healthcare provider based on the patient's blood glucose levels and individual insulin requirements. The nurse should follow the prescribed insulin orders and not administer insulin without an order.

Choice D rationale: Indicated. Insulin glargine is a long-acting basal insulin used to provide a steady background insulin level throughout the day. The nurse should administer the prescribed insulin glargine dose as ordered.

Choice E rationale: Contraindicated. Insulin lispro is a rapid-acting insulin, and insulin glargine is a long-acting insulin. Mixing different types of insulin in one syringe can alter their pharmacokinetics and lead to inconsistent blood glucose control. Insulin lispro and insulin glargine should be administered separately.