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A nurse is mixing NPH insulin and regular insulin prior to administration. Which of the following actions should the nurse take first?

Inject air into the vial with regular insulin in it.

Draw up the NPH insulin dose.

Inject air into the vial with NPH insulin in it.

Draw up the regular insulin dose.

Answer and Explanation

The Correct Answer is C

Answer: C

Rationale:

A) Inject air into the vial with regular insulin in it:

Injecting air into the vial of regular insulin is part of the correct procedure but not the initial step. This action is typically performed after the NPH insulin vial has been handled, as part of the process to prevent contamination and maintain the correct insulin types.

B) Draw up the NPH insulin dose:

Drawing up the NPH insulin dose should follow the initial steps of air injection. It is important to manage the insulin types in the correct sequence to ensure that the regular insulin remains uncontaminated by the NPH insulin.

C) Inject air into the vial with NPH insulin in it:

Injecting air into the NPH insulin vial first helps to equalize the pressure and avoid contamination when drawing up the insulin. This step is crucial to ensure that the NPH insulin is not inadvertently mixed with the regular insulin, maintaining the integrity of each type.

D) Draw up the regular insulin dose:

Drawing up the regular insulin dose should occur after air has been injected into both vials. This ensures that the NPH insulin is not drawn into the regular insulin syringe, which could affect the medication's efficacy.

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Correct Answer is B

Explanation

A. “Give diphenhydramine IM”: While diphenhydramine, an antihistamine, can be used in the treatment of allergic reactions, it is not the first-line treatment for anaphylaxis. Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires immediate treatment with epinephrine.

B. “Administer epinephrine IM”: Epinephrine is the first-line treatment for anaphylaxis. It works rapidly to reverse the life-threatening symptoms of anaphylaxis, including airway swelling and severe low blood pressure. Therefore, after stopping the medication infusion and assessing the client’s respiratory status, the nurse should administer epinephrine IM.

C. “Replace the infusion with 0.9% sodium chloride”: While replacing the infusion with 0.9% sodium chloride (normal saline) can help maintain venous access and hydration, it is not the immediate priority in the treatment of anaphylaxis. The first priority is to administer epinephrine.

D. “Elevate the client’s legs and feet”: Elevating the client’s legs and feet can help improve blood flow and may be beneficial in the treatment of anaphylaxis. However, it is not the immediate priority. The first priority is to administer epinephrine. After administering epinephrine and ensuring the client’s airway is open, the nurse can then take measures to make the client more comfortable, such as elevating the legs and feet.

A. "Take a daily potassium supplement." B. "Increase the amount of sodium in your diet." C. "Exercise caution when changing positions." D. "Monitor your pulse rate before taking medication."

Correct Answer is C

Explanation

A) "Take a daily potassium supplement."
Captopril, an angiotensin-converting enzyme (ACE) inhibitor, can lead to hyperkalemia (high potassium levels) by decreasing the excretion of potassium. Supplementing potassium without medical supervision can exacerbate this effect and potentially cause life-threatening hyperkalemia. Patients should be monitored for potassium levels and should not take potassium supplements unless directed by their healthcare provider.

B) "Increase the amount of sodium in your diet."
Increasing sodium intake is generally contraindicated in patients taking captopril, especially those with hypertension or heart failure, as it can counteract the drug's antihypertensive effects. A lower sodium intake is often recommended to help control blood pressure more effectively.

C) "Exercise caution when changing positions."
Captopril can cause orthostatic hypotension, a condition where blood pressure drops significantly when a person stands up quickly, leading to dizziness, lightheadedness, and an increased risk of falls. Advising the patient to rise slowly from sitting or lying positions helps prevent these symptoms and ensures safety.

D) "Monitor your pulse rate before taking medication."
While monitoring the pulse can be important for patients on certain cardiovascular medications like beta-blockers, it is not typically necessary for patients taking captopril. The primary concerns with captopril are its effects on blood pressure and renal function rather than the pulse rate.

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