A nurse is teaching a client who is newly diagnosed with type 2 diabetes mellitus about insulin therapy. Which of the following insulin combinations should the nurse instruct the client to mix?

A. "This device delivers heat via electrodes that are attached to the affected area.": A TENS unit does not use heat for pain relief. It works by delivering low-voltage electrical impulses to the skin, stimulating nerve fibers to reduce pain perception.

B. "Adjust the dial until you feel a pins-and-needles sensation.": The intensity of the electrical stimulation should be adjusted to a comfortable level where the client feels a tingling or pins-and-needles sensation. This indicates that the nerves are being stimulated appropriately for pain relief.

C. "You can apply the electrodes directly over sensitive areas of skin.": Electrodes should not be placed on irritated, broken, or sensitive skin, as this can cause discomfort or skin damage. Placement should follow guidelines to ensure effective and safe pain management.

D. "This device requires access to a 220-volt outlet.": TENS units are battery-operated and do not require a high-voltage power source. This makes them portable and convenient for home use.

Anticipated:

• Metoprolol 5 mg every 2 to 3 min up to three doses
• Oxygen at 2 L/min via nasal cannula
• Draw electrolytes along with Hgb and Hct
• Morphine 6 mg IV bolus every 3 hr as needed for pain
• Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses

Nonessential:

• Obtain daily weight

Contraindicated:

• Atropine 0.5 mg IV bolus every 5 min up to 2 mg

Rationale:

• Metoprolol 5 mg every 2 to 3 min up to three doses: Beta-blockers reduce myocardial oxygen demand by decreasing heart rate and blood pressure, making them beneficial in acute coronary syndrome. They should be used cautiously in patients with signs of heart failure or bradycardia.
• Oxygen at 2 L/min via nasal cannula: Supplemental oxygen is recommended for clients with acute coronary syndrome when oxygen saturation is below 94% to optimize myocardial oxygen supply and prevent ischemia.
• Draw electrolytes along with Hgb and Hct: Electrolytes are critical in evaluating myocardial function, and hemoglobin/hematocrit levels help assess perfusion and oxygen-carrying capacity.
• Morphine 6 mg IV bolus every 3 hr as needed for pain: Morphine is used to relieve severe chest pain in myocardial infarction and reduce myocardial oxygen demand by decreasing anxiety and preload.
• Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses: Nitroglycerin dilates coronary arteries, improving oxygen delivery to the myocardium, and reduces preload and afterload, alleviating chest pain. It is a first-line treatment for angina and myocardial infarction but should be avoided in cases of hypotension.
• Obtain daily weight: Daily weight monitoring is primarily used for fluid balance assessment in conditions like heart failure rather than for acute myocardial infarction management.
• Atropine 0.5 mg IV bolus every 5 min up to 2 mg: Atropine is used to treat bradycardia. However, the client is tachycardic, so atropine would worsen the condition and is contraindicated.