A nurse is preparing to administer methylprednisolone 60 mg IM to a client. Available is methylprednisolone 80 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest hundredth. Use a leading zero if it applies. Do not use a trailing zero.)

Insulin therapy management involves the precise coordination of short-actingand intermediate-actingagents to mimic physiological glucose regulation. Regular insulinacts rapidly, whereas NPH insulincontains protamine to delay absorption and extend the duration of action. Proper mixing technique is vital to maintain the integrity of each medication and ensure accurate glycaemic control without causing cross-contamination.

Rationale:

A.Injecting air into both vials is the correct first step when mixing insulins to prevent the creation of a vacuum. The nurse must teach the client to inject air equal to the dose into the NPH vial first, followed by air into the regular vial. This equalization of pressure allows for the smooth withdrawal of the liquid medication without contaminating the regular insulin with NPH.

B.Shaking insulin vials vigorously is contraindicated as it creates air bubbles that interfere with accurate dose measurement and can denature the protein molecules. Instead, NPH insulin, which is a suspension, should be gently rolled between the palms to redistribute the particles. Regular insulin is a clear solution and does not require any agitation or rolling before withdrawal from the vial.

C.Drawing up NPH insulin first is an incorrect technique that risks contaminating the clear regular insulin vial with the cloudy protamine from the NPH. The standard protocol is to draw the "clear before cloudy" (regular before NPH) to ensure the fast-acting insulin remains pure. Contamination of the regular vial with NPH would inadvertently alter the onset and peak characteristics of the short-acting dose.

D.Inserting the needle at a 15° angle is incorrect for subcutaneous insulin administration and is more appropriate for intradermal injections. Insulin must be deposited into the fatty subcutaneous tissue, typically at a 45° to 90° angle depending on the patient's body mass and needle length. A 15° angle would likely result in an ineffective intradermal delivery, leading to unpredictable absorption rates.

Hyperkalemiais a critical electrolyte disturbance defined by a serum potassium level exceeding 5.0 mEq/L, which alters the resting membrane potentialof excitable tissues. This condition often results from renal failure, metabolic acidosis, or cellular injury, leading to cardiac dysrhythmiasand neuromuscular weakness. Clinical management involves stabilizing the myocardium, shifting potassium intracellularly, and facilitating the definitive excretionof the excess cation from the body to prevent cardiac arrest.

Rationale:

Administering sodium polystyrenerectally is appropriateas it acts as a cation-exchange resin to remove excess potassium from the body. It works in the large intestine by exchanging sodium ions for potassium ions, which are then excreted through the feces. This provides a definitive method for lowering the total body potassiumload in a client with a serum level of 6 mEq/L.

Administering potassium chloride IV is inappropriateand life-threatening for this client because their serum potassium level is already critically elevated at 6 mEq/L. Adding more exogenous potassium would exacerbate the hyperkalemic state, leading to worsening cardiac conduction delays or ventricular fibrillation. The primary goal for this client is potassium reduction, not supplementation or replacement.

Administering insulin IVis appropriatebecause it stimulates the sodium-potassium ATPase pump, facilitating the rapid shift of potassium from the extracellular fluid into the intracellular compartment. This provides a temporary but life-saving reduction in serum potassium levels. Intravenous dextrose is typically co-administered to prevent hypoglycemiaunless the client’s blood glucose is already significantly elevated.

Administering hydralazine IVis inappropriatebecause this client is already experiencing low blood pressure, with a reading of 98/54 mm Hg at 1100. Hydralazine is a direct-acting vasodilatorused to treat hypertension by relaxing vascular smooth muscle. Giving a vasodilator to a hypotensive client would lead to severe hemodynamic collapse and further compromise organ perfusion.

Administering calcium gluconate IVis appropriateas a first-line emergency intervention to stabilize the myocardial cell membrane. While calcium does not lower the serum potassium level, it antagonizes the cardiotoxic effects of hyperkalemia by increasing the threshold potential. This helps prevent lethal arrhythmias, such as the progression from the current peaked T waves to sinusoidal rhythmsor asystole.