A nurse is teaching a client how to draw up regular insulin and NPH insulin in the same syringe. Which of the following instructions should the nurse include?

Inject air into the regular insulin first.

Shake the NPH insulin until it is well mixed.

Draw up the NPH insulin into the syringe first.

Discard regular insulin that appears cloudy.

Answer and Explanation

The Correct Answer is D

Choice A reason: This is incorrect. When mixing regular (clear) and NPH (cloudy) insulin, air should be injected into the NPH vial first, then into the regular insulin vial. This prevents contamination of the regular insulin with NPH insulin.

Choice B reason: This is incorrect because the nurse should not shake the NPH insulin vial, but rather roll it gently between the palms to mix it. Shaking can cause bubbles and affect the accuracy of the dose.

Choice C reason: This is incorrect because the nurse should draw up the regular insulin into the syringe first, then the NPH insulin. This prevents mixing of the NPH insulin with the regular insulin in the vial.

Choice D reason: This is correct. Regular insulin should always be clear. If it appears cloudy, it may be contaminated or expired and should be discarded.

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Correct Answer is A

Explanation

Choice A reason: This is correct because hemoglobin A1C level reflects the average blood glucose level over the past 2 to 3 months. It is a reliable indicator of the patient's glycemic control and adherence to the antidiabetic therapy. The goal for most patients with type 2 diabetes is to keep the hemoglobin A1C level below 7%.

Choice B reason: This is incorrect because serum insulin level is not a good measure of the patient's adherence to the antidiabetic therapy, as it may vary depending on the type, dose, and timing of the insulin or oral antidiabetic agents. Serum insulin level may also be affected by other factors, such as stress, infection, or exercise.

Choice C reason: This is incorrect because fingerstick fasting blood glucose level only reflects the blood glucose level at a single point in time. It does not provide information about the patient's long-term glycemic control or adherence to the antidiabetic therapy. Fingerstick fasting blood glucose level may also be influenced by the patient's diet, activity, or medication intake before the test.

Choice D reason: This is incorrect because hemoglobin level is not related to the patient's adherence to the antidiabetic therapy, as it measures the amount of oxygen-carrying protein in the red blood cells. Hemoglobin level may be affected by conditions such as anemia, dehydration, or blood loss.

A. Constipation B. Clotting C. Tinnitus D. Urinary retention

Correct Answer is B

Explanation

Choice A reason: Constipation is not an adverse effect of tamoxifen. Tamoxifen does not affect the gastrointestinal motility or function. Constipation may be caused by other factors such as dehydration, low-fiber diet, or lack of exercise.

Choice B reason: Clotting is an adverse effect of tamoxifen. Tamoxifen can increase the risk of thromboembolic events such as deep vein thrombosis, pulmonary embolism, or stroke. Clotting can cause serious complications such as pain, swelling, shortness of breath, chest pain, or neurological deficits.

Choice C reason: Tinnitus is not an adverse effect of tamoxifen. Tamoxifen does not affect the auditory system or cause hearing loss. Tinnitus may be caused by other factors such as noise exposure, ear infection, or medication toxicity.

Choice D reason: Urinary retention is not an adverse effect of tamoxifen. Tamoxifen does not affect the urinary system or cause bladder dysfunction. Urinary retention may be caused by other factors such as prostate enlargement, nerve damage, or medication side effects.

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A nurse is teaching a client how to draw up regular insulin and NPH insulin in the same syringe. Which of the following instructions should the nurse include?

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