A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take?

Choice A reason: A 32-year-old client who has benign breast disease does not have a contraindication for receiving oral contraceptives. Benign breast disease is not associated with an increased risk of breast cancer or thromboembolic events. However, the nurse should advise the client to perform regular breast self-examinations and report any changes.

Choice B reason: A 26-year-old client who has migraine headaches at the start of each menstrual cycle does not have a contraindication for receiving oral contraceptives. Migraine headaches that are related to the menstrual cycle may actually improve with oral contraceptives, as they can regulate the hormonal fluctuations. However, the nurse should monitor the client for any signs of stroke or hypertension, as these are rare but serious complications of oral contraceptives.

Choice C reason: A 28-year-old client who has a history of pelvic inflammatory disease does not have a contraindication for receiving oral contraceptives. Pelvic inflammatory disease is an infection of the reproductive organs that can cause infertility, chronic pain, and ectopic pregnancy. Oral contraceptives can reduce the risk of pelvic inflammatory disease by creating a thick cervical mucus that prevents the entry of bacteria. However, the nurse should remind the client that oral contraceptives do not protect against sexually transmitted infections, and that barrier methods should be used in addition.

Choice D reason: A 38-year-old client who reports smoking one pack of cigarettes every day has a contraindication for receiving oral contraceptives. Smoking increases the risk of cardiovascular diseases, such as myocardial infarction, stroke, and peripheral vascular disease. Oral contraceptives also increase the risk of these diseases, especially in women older than 35 years. Therefore, the combination of smoking and oral contraceptives can have a synergistic effect and cause serious harm. The nurse should recommend other methods of contraception for this client, such as intrauterine devices, implants, or injections.

Choice A reason: Rotating the injection sites within the same location for a week is not correct. The client should rotate the injection sites within the same location each day to prevent lipodystrophy and ensure consistent absorption.

Choice B reason: Storing the unopened vials of insulin in the freezer is not correct. The client should store the unopened vials of insulin in the refrigerator, not the freezer, to prevent damage to the insulin.

Choice C reason: Drawing up the regular insulin before the NPH insulin is correct. The client should draw up the clear (regular) insulin before the cloudy (NPH) insulin to prevent contamination of the regular insulin with the NPH insulin.

Choice D reason: Injecting the insulin into the muscle for faster absorption is not correct. The client should inject the insulin into the subcutaneous tissue, not the muscle, to ensure appropriate absorption and prevent hypoglycemia.