History and Physical

The client is a 26-year-old female with acute appendicitis. She has a 12-year history of type 1 diabetes and no other significant medical histor The appendectomy was completed without issue, and the client will be admitted to the surgical floor to recover.

For each nursing action below, click to specify if the action is indicated, contraindicated or non-essential.

Choice A rationale: Quinapril is an ACE inhibitor and, like captopril, is typically given twice daily. It does not have an extended duration of action that would allow for once-daily dosing.

Choice B rationale: Lisinopril is an ACE inhibitor that can be given once per day. It has a long duration of action, which allows for once-daily dosing. This makes it a convenient option for patients who have difficulty remembering to take their medications multiple times a day.

Choice C rationale: Ramipril is another ACE inhibitor that can be given once per day. Like lisinopril, it has an extended duration of action, allowing for once-daily dosing.

Choice D rationale: Trandolapril is an ACE inhibitor that can also be given once per day. It has a prolonged duration of action, which supports once-daily dosing for optimal blood pressure control.

Choice E rationale: Captopril itself is listed in the options, and it is not an ACE inhibitor that can be given only once per day. Captopril has a short duration of action and is usually prescribed for twice-daily dosing.

Choice A rationale: This is essential to ensure that the insulin is not discolored or cloudy, as these changes could indicate a problem with the insulin's stability or effectiveness.
Choice B rationale: While it is essential to have a complete history and physical for proper patient care, double-checking this with another nurse is not necessary in the immediate administration of insulin lispro.
Choice C rationale: Double-checking the dose of insulin in the syringe is crucial to avoid medication errors and ensure that the correct amount is being administered to the patient.
Choice D rationale: The sliding scale order is not mentioned in the information provided, and since it is not part of the immediate insulin administration, it does not need to be double-checked in this context.
Choice E rationale: Checking the expiration date is necessary to ensure that the insulin is still within its usable period. Using expired insulin can lead to reduced potency and potentially ineffective blood sugar control.
Choice F rationale: The information provided in the nurse's notes does not indicate that insulin administration is due at a specific site (e.g., subcutaneous injection). Therefore, there is no need for a second nurse to double-check the site at this moment. However, it's important for the administering nurse to choose the appropriate site following the facility's guidelines and rotate injection sites to prevent lipodystrophy.

Choice G rationale: Different types of insulin come in different concentrations (e.g., U-100, U-200). It's important to confirm that the correct concentration is being used to ensure accurate dosing.
Choice H rationale: The nurse should verify that the insulin to be administered is indeed insulin lispro, as indicated in the medication order. Administering the wrong type of insulin can have significant implications for the patient's blood sugar control.