A nurse is preparing to administer insulin to a client who has diabetes mellitus. The nurse notices that the insulin vial has a small amount of white precipitate at the bottom. Which of the following actions should the nurse take?

A) This is incorrect because discarding the vial and obtaining a new one is not necessary actions for a vial of insulin that has a small amount of white precipitate at the bottom. This precipitate indicates that the insulin has crystallized due to cold storage or temperature changes, but it can be resuspended by gently rolling or rotating the vial.

B) This is incorrect because shaking the vial vigorously until the precipitate dissolves is not an appropriate action for a vial of insulin that has a small amount of white precipitate at the bottom. Shaking the vial may cause air bubbles or froth to form, which can affect the accuracy of the dose measurement and administration.

C) This is incorrect because warming the vial in a microwave oven for a few seconds is not a safe action for a vial of insulin that has a small amount of white precipitate at the bottom. Warming the vial in a microwave oven may cause uneven heating or damage to the insulin molecules, which can alter the potency and effectiveness of the medication.

D) This is correct because rolling the vial gently between the palms of both hands is the recommended action for a vial of insulin that has a small amount of white precipitate at the bottom. Rolling the vial gently helps to resuspend the insulin crystals and restore the uniform appearance of the solution.

A) This is correct because blood in the urine (hematuria) is a sign of bleeding that should be reported to the provider. Warfarin is an anticoagulant that can increase the risk of bleeding from any site in the body.

B) This is correct because a headache that lasts for more than an hour is a sign of bleeding that should be reported to the provider. Warfarin can increase the risk of bleeding in the brain (intracranial hemorrhage), which can manifest as a severe or persistent headache, confusion, or neurological deficits.

C) This is correct because black, tarry stools (melena) are a sign of bleeding that should be reported to the provider. Warfarin can increase the risk of bleeding in the gastrointestinal tract (GI bleed), which can manifest as dark or bloody stools, abdominal pain, or vomiting blood.

D) This is correct because a sore throat and a fever are signs of bleeding that should be reported to the provider. Warfarin can increase the risk of bleeding in the mucous membranes (mucosal bleeding), which can manifest as sore throat, mouth ulcers, nosebleeds, or gum bleeding. A fever may indicate an infection that can worsen the bleeding tendency.

E) This is incorrect because bruising on the arms and legs (ecchymosis) is not a sign of bleeding that should be reported to the provider. Warfarin can cause minor bruising due to subcutaneous bleeding, which is usually harmless and does not require treatment. However, if the bruising is extensive, painful, or accompanied by other signs of bleeding, then it should be reported to the provider.