An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?

Reference Range:

Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]

Instruct the client that since the hematocrit remains low, the daily injections are still necessary.

Notify the healthcare provider of the patient's hematocrit level so the frequency of injections can be reduced.

Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition.

Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.

Answer and Explanation

The Correct Answer is D

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary: A hematocrit of 43% is within the normal range, suggesting the client’s anemia is improving. If the hematocrit were still low, continuing daily injections would be appropriate, but this is not the case here.

B. Notify the healthcare provider of the client’s hematocrit level so the frequency of injections can be reduced: Since the hematocrit is normal, there is no need to notify the healthcare provider specifically for changing the injection frequency based solely on the hematocrit level. Reducing injection frequency should be based on the overall treatment plan and not just the current hematocrit.
C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition: While the medication may be effective, informing the client about the potential for less frequent injections could improve adherence and reduce discomfort, if the healthcare provider approves.
D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections: Teaching self-administration can empower the client and potentially reduce discomfort by allowing the client to become more comfortable with the process. It also offers the opportunity for the client to manage their injections more conveniently and with greater control.

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Correct Answer is C

Explanation

A) Pull up 30 units from the 70/30 vial, but only administer one third: The 70/30 insulin vial contains a mixture of 70% isophane (NPH) insulin and 30% regular insulin. If 30 units of this mixture are drawn, the actual amount of regular insulin would be 30% of 30 units, which equals 9 units. This does not equate to the 10 units of regular insulin required, making this option inaccurate for precise dosing.
B) Withdraw ten units regular insulin from the 70/30 vial: The 70/30 vial provides a fixed ratio of regular to NPH insulin. Extracting 10 units from this vial would not yield exactly 10 units of regular insulin; instead, it would include both types in the specified ratio, leading to an incorrect dosage of regular insulin.
C) Withhold the dose until insulin regular is available on the unit: Since the 70/30 vial contains a mixture and not solely regular insulin, it is necessary to withhold the dose until a vial of regular insulin is available. This ensures that the precise amount of regular insulin needed is administered, avoiding the imprecision and potential errors that could arise from using a mixed insulin vial.
D) Obtain a new vial of regular insulin and withdraw ten units: While obtaining a new vial of regular insulin is the correct approach for ensuring accurate dosing, the option of withdrawing ten units directly from a vial of regular insulin is not feasible if the current medication available is a mixture. This option assumes that the correct type of insulin is already available for use.

A. Administer an oral analgesic and evaluate its effectiveness before applying the new patch. B. Apply the new patch in a different location after removing the original patch. C. Remove the patch and consult with the healthcare provider about the client's pain resolution. D. Place the patch on the client's shoulder and leave both patches in place for 12 hours.

Correct Answer is B

Explanation

A) Administer an oral analgesic and evaluate its effectiveness before applying the new patch: This action is unnecessary because the client reports no pain. Administering an oral analgesic would not be appropriate when the client denies pain and the previous fentanyl patch is intact.
B) Apply the new patch in a different location after removing the original patch: This is the correct action. Fentanyl patches should be replaced with new ones in a different location to prevent overdosing and ensure proper absorption. The old patch should be removed to avoid accumulation of excess medication.
C) Remove the patch and consult with the healthcare provider about the client's pain resolution: There is no need to consult the healthcare provider or remove the patch if the client denies pain and the patch is intact. The issue is with replacing the patch rather than evaluating pain.
D) Place the patch on the client's shoulder and leave both patches in place for 12 hours: This is unsafe. Applying a new patch without removing the old one can lead to overdose due to excessive fentanyl. The old patch must be removed before placing a new one.

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Based on the capillary glucose measurement, a client is to receive 10 units of regular insulin. The client's medication drawer contains one vial of a 70/30 mixture of regular Insulin and Isophane insulin How should the nurse prepare the prescribed dose?

Correct Answer is C

Explanation

When preparing to apply a scheduled fentanyl transdermal patch, the nurse notes that the previously applied patch is intact on the client's upper back and the client denies pain. Which action should the nurse take?

Correct Answer is B

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