A nurse is providing teaching for a client who has diabetes mellitus about the self-administration of insulin. The client has prescriptions for regular and NPH insulins. Which of the following statements by the client indicates an understanding of the teaching?

"I will draw the regular insulin into the syringe first."

"I will store prefilled syringes in the refrigerator with the needle pointed upward."

"I will gently roll the NPH vial between my hands before drawing up the insulin."

"I will insert the needle at a 90-degree angle."

Answer and Explanation

The Correct Answer is A

Choice A reason: Drawing the regular insulin into the syringe first is correct. When mixing two types of insulin, the clear (regular) insulin should be drawn up before the cloudy (NPH) insulin to prevent contamination.

Choice B reason: Storing prefilled syringes with the needle pointed upward can cause air bubbles to move into the insulin, which can alter the dose when injected. The needle should be pointed downward.

Choice C reason: Shaking the NPH vial vigorously is not recommended as it can create air bubbles and affect the insulin dose. Instead, the vial should be gently rolled between the hands to mix the insulin.

Choice D reason: Inserting the needle at a 15-degree angle is incorrect for subcutaneous injections. A 90-degree angle is typically used unless the patient is very thin, in which case a 45-degree angle may be used.

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Correct Answer is B

Explanation

Choice A reason: Changing the ostomy pouch daily is not necessary and could lead to skin irritation from the frequent removal and application of the adhesive. Ostomy pouches are designed to be worn for several days, and the schedule for changing them can vary based on the type of pouch and individual needs.

Choice B reason: Emptying the ostomy pouch when it is 2/3 full is the correct instruction. This prevents the pouch from becoming too heavy, which could pull on the stoma and cause discomfort or damage. It also reduces the risk of leaks and odors.

Choice C reason: Trimming the opening of the ostomy seal to be 1/2 inch wider than the stoma is incorrect. The opening should be trimmed to match the size of the stoma to provide a secure fit and prevent leakage of the contents onto the skin, which could cause irritation or infection.

Choice D reason: Applying lotion to the peristomal skin when changing the ostomy pouch is not recommended. Lotions or creams can interfere with the adhesive of the ostomy appliance and reduce the effectiveness of the seal. The peristomal skin should be clean and dry to ensure the best adherence of the ostomy appliance.

A. 150 mL of serosanguineous drainage B. 75 mL of greenish-yellow drainage C. 100 mL of red drainage D. 200 mL of brown drainage

Correct Answer is C

Explanation

Choice A reason: Serosanguineous drainage, which is a mixture of blood and a clear yellow liquid known as serum, is generally expected after surgery. While the amount of 150 mL may seem significant, it is not uncommon in the first hour postoperatively, especially after abdominal surgery. The nurse should continue to monitor the drainage and report if the volume increases significantly or if the drainage becomes bright red, indicating active bleeding.

Choice B reason: Greenish-yellow drainage is typically bile, which can be present in NG tube drainage after abdominal surgery. This type of drainage is not unusual and does not necessarily need to be reported unless accompanied by other concerning symptoms or changes in the patient's condition.

Choice C reason: 100 mL of red drainage is concerning and should be reported to the provider immediately. Red drainage suggests active bleeding, and in the context of the first postoperative hour, it could indicate a complication such as hemorrhage. Prompt assessment and intervention are required to address this potential emergency situation.

Choice D reason: Brown drainage may be old blood or could be related to the contents of the gastrointestinal tract. While 200 mL is a larger volume, brown drainage is not typically as concerning as bright red drainage. However, the nurse should monitor for changes in the color and consistency of the drainage, as well as the patient's vital signs and overall status.

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A nurse is providing teaching for a client who has diabetes mellitus about the self-administration of insulin. The client has prescriptions for regular and NPH insulins. Which of the following statements by the client indicates an understanding of the teaching?

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