A nurse is collecting data from a client who reports feeling stress. Which of the following should the nurse identify as an external stressor?

A) A recent move to a new city: A move to a new city is an example of an external stressor. External stressors are environmental or situational factors that create stress, such as life changes, events, or challenges in the outside world. Relocating can involve significant adjustments, such as adapting to a new community, finding housing, and establishing new social connections, all of which can cause stress.

B) Lack of nutritional knowledge: Lack of nutritional knowledge is an internal stressor, as it involves an individual's beliefs, attitudes, and understanding. While it can cause stress, it is a personal factor rather than an external, environmental one.

C) Report of feeling depressed: Feelings of depression are an internal stressor because they are related to an individual’s emotional state or mental health. This reflects the client's internal experience rather than an external environmental factor.

D) Recurring urinary tract infections: Recurring urinary tract infections (UTIs) are a health-related concern and can be seen as a physiological stressor. However, they are not strictly external; they are related to the individual’s health and body rather than external environmental circumstances.

A) "Draw up the insulin lispro and insulin glargine in separate syringes.":
Insulin lispro (a rapid-acting insulin) and insulin glargine (a long-acting insulin) should be administered separately, as they have different properties and mechanisms of action. Mixing them in one syringe can affect their effectiveness and may cause inaccurate dosing. Therefore, the nurse should instruct the client to draw up each insulin in a separate syringe to ensure proper administration and action of both insulins.

B) "Take an extra dose of insulin lispro prior to aerobic exercise.":
Taking an extra dose of insulin lispro before exercise is not recommended unless directed by a healthcare provider. Exercise can lower blood glucose levels, and additional insulin may increase the risk of hypoglycemia. Instead, clients with diabetes are typically advised to monitor their blood glucose levels before and after exercise and adjust their insulin dose or carbohydrate intake accordingly, under the guidance of their healthcare provider.

C) "Expect insulin glargine to be cloudy.":
Insulin glargine is a clear, long-acting insulin. It should not be cloudy. If the insulin appears cloudy, it may be a sign that the insulin has been improperly stored or is no longer effective. The nurse should educate the client to inspect the insulin for cloudiness or particles and to discard any insulin that appears abnormal.

D) "Anticipate that the insulin glargine will peak in 3 hours.":
Insulin glargine is a long-acting insulin that does not have a pronounced peak. It provides a steady release of insulin over 24 hours and helps to maintain baseline insulin levels. It is not meant to peak like rapid-acting or short-acting insulins. Therefore, this instruction is incorrect, as insulin glargine does not follow the same peak-action pattern as other insulins.