A nurse is reinforcing teaching with client who has diabetes mellitus and is taking insulin lispro and insulin glargine. Which the following instructions should the nurse include in the teaching?

"Draw up the insulin lispro and insulin glargine in separate syringes.

"Take an extra dose of insulin lispro prior to aerobic exercise."

‘’Expect insulin glargine to be cloudy."

"Anticipate that the insulin glargine will peak in 3 hours."

Answer and Explanation

The Correct Answer is A

A) "Draw up the insulin lispro and insulin glargine in separate syringes.":
Insulin lispro (a rapid-acting insulin) and insulin glargine (a long-acting insulin) should be administered separately, as they have different properties and mechanisms of action. Mixing them in one syringe can affect their effectiveness and may cause inaccurate dosing. Therefore, the nurse should instruct the client to draw up each insulin in a separate syringe to ensure proper administration and action of both insulins.

B) "Take an extra dose of insulin lispro prior to aerobic exercise.":
Taking an extra dose of insulin lispro before exercise is not recommended unless directed by a healthcare provider. Exercise can lower blood glucose levels, and additional insulin may increase the risk of hypoglycemia. Instead, clients with diabetes are typically advised to monitor their blood glucose levels before and after exercise and adjust their insulin dose or carbohydrate intake accordingly, under the guidance of their healthcare provider.

C) "Expect insulin glargine to be cloudy.":
Insulin glargine is a clear, long-acting insulin. It should not be cloudy. If the insulin appears cloudy, it may be a sign that the insulin has been improperly stored or is no longer effective. The nurse should educate the client to inspect the insulin for cloudiness or particles and to discard any insulin that appears abnormal.

D) "Anticipate that the insulin glargine will peak in 3 hours.":
Insulin glargine is a long-acting insulin that does not have a pronounced peak. It provides a steady release of insulin over 24 hours and helps to maintain baseline insulin levels. It is not meant to peak like rapid-acting or short-acting insulins. Therefore, this instruction is incorrect, as insulin glargine does not follow the same peak-action pattern as other insulins.

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Correct Answer is B

Explanation

A) Too many choices can be overwhelming and lead to increased frustration or "decision fatigue" for a confused client.

B) Delirium is characterized by an acute, fluctuating change in mental status. Reorientation helps anchor the client to reality and can reduce the anxiety or agitation associated with cognitive clouding.

C) Ignoring a client's fears can increase their sense of isolation and paranoia. Acknowledging feelings while gently correcting misconceptions is more therapeutic.

D) Consistency is key. Frequent changes in staff increase confusion; it is better to have the same nursing team to build familiarity.

A. Turn on overhead lights briefly when checking IV line B. Open curtains between clients semiprivate rooms C. Conduct change-of-shift report near the clients’ rooms. D. Wear shoes with rubber soles

Correct Answer is D

Explanation

A) "Turn on overhead lights briefly when checking IV line.": Turning on overhead lights can disrupt the client’s sleep, especially if done during the night. Light exposure can interfere with the body’s natural circadian rhythm, making it harder for the client to fall asleep and stay asleep. A more appropriate action would be to use a dim light or portable light to minimize disturbance.

B) "Open curtains between clients’ semiprivate rooms.": Opening the curtains between semiprivate rooms could increase noise and visual distractions, which may disturb the client's sleep. Keeping the environment as calm and private as possible is essential to reduce stress and promote restful sleep. Curtains should ideally remain closed to promote privacy and minimize distractions.

C) "Conduct change-of-shift report near the clients’ rooms.": Conducting report near the client's rooms can create unnecessary noise and disturb the client’s sleep. The change-of-shift report should ideally take place in a designated area, away from patient rooms, to reduce noise and disturbances in the environment.

D) "Wear shoes with rubber soles.": Wearing shoes with rubber soles reduces noise when walking, which is particularly important in an acute care setting where patients need rest. Quiet movement helps to maintain a peaceful environment, reducing the environmental stressors that can impact sleep quality for clients.

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