A nurse is reinforcing teaching with a client who is scheduled for lithotripsy about conditions that can contribute to the formation of renal calculi. Which of the following conditions should the nurse include?

Choice A rationale
Freezing unopened insulin vials is incorrect. Insulin should be stored in the refrigerator at a temperature between 36°F and 46°F (2°C and 8°C) until it is opened. Freezing insulin can cause it to lose its potency and effectiveness. Once opened, insulin vials can be kept at room temperature for up to 28 days, but they should never be frozen.
Choice B rationale

Increasing insulin when exercising is incorrect. Exercise generally lowers blood glucose levels, so clients with type 1 diabetes may need to decrease their insulin dose or consume additional carbohydrates to prevent hypoglycemia during and after physical activity. It is important for clients to monitor their blood glucose levels closely and adjust their insulin and carbohydrate intake accordingly.
Choice C rationale
Injecting insulin into the abdominal area is correct. The abdominal area is one of the recommended sites for insulin injection because it has a large surface area and provides consistent absorption. Other recommended sites include the upper outer arms, thighs, and buttocks. Rotating injection sites within the same area helps prevent lipodystrophy and ensures better insulin absorption.
Choice D rationale
Shaking the insulin vial vigorously to mix is incorrect. Insulin vials should be gently rolled between the hands to mix the contents. Shaking the vial vigorously can cause air bubbles to form, which can lead to inaccurate dosing. Proper mixing ensures that the insulin is evenly distributed and effective.

Choice A rationale
While feeling depressed is a significant concern, it is not the highest priority in the context of systemic lupus erythematosus (SLE). Depression should be addressed, but it does not pose an immediate threat to the client’s physical health.
Choice B rationale
Joint pain in hands and knees is a common symptom of SLE but is not the highest priority. It indicates inflammation but does not pose an immediate risk to the client’s overall health.
Choice C rationale
A dry, raised rash on the face, often referred to as a “butterfly rash,” is a characteristic symptom of SLE. However, it is not the highest priority to report as it does not pose an immediate threat.
Choice D rationale
Presence of peripheral edema is the highest priority to report because it can indicate kidney involvement, which is a serious complication of SLE. Kidney damage can lead to significant health issues and requires immediate attention.