Find information about a client below.
What should the nurse double-check with a second nurse? Select all that apply.
The insulin vial for color and clarity
The history and physical with the diabetes diagnosis listed C The dose of insulin drawn up in the syringe
The sliding scale insulin lispro order E The expiration date on the insulin vial
The site for the insulin administration G The insulin concentration H The type of insulin to be administered
The site for the insulin administration
The insulin concentration
The type of insulin to be administered
Correct Answer : A,C,E,G
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
a) Assess the client for side effects of carbamazepine:
- This option might seem reasonable as monitoring for side effects is essential with any medication, especially one with a narrow therapeutic range like carbamazepine. However, the client's level of 8.4 mcg/L is within the therapeutic range (4 to 12 mcg/mL), so there's no immediate indication that side effects are likely to occur solely based on this level.
b) Notify the healthcare provider of the carbamazepine level:
- While it's important to keep the healthcare provider informed about the client's condition, in this case, the carbamazepine level is within the therapeutic range. There's no urgent need to notify the provider unless there are other concerning factors not mentioned in the scenario.
c) Administer the carbamazepine as prescribed:
- This is the correct answer. The client's morning carbamazepine level of 8.4 mcg/L falls within the therapeutic range (4 to 12 mcg/mL). Therefore, the evening dose should be administered as prescribed to maintain therapeutic levels and control the client's condition.
d) Withhold this dose of the carbamazepine:
- Withholding the dose based solely on the morning carbamazepine level of 8.4 mcg/L, which is within the therapeutic range, would not be appropriate. Withholding the dose without consulting the healthcare provider could potentially lead to suboptimal management of the client's condition.
Correct Answer is C
Explanation
A. Bedtime is the best time to take the tablet.While taking medication at bedtime can sometimes be convenient, it is not necessarily the best time for iron absorption. Iron is best absorbed on an empty stomach, and bedtime might not always align with this condition.
B. Crush the tablets and mix with pudding.Crushing enteric-coated tablets is not recommended because it destroys the coating designed to protect the stomach lining from irritation and to ensure the iron is released in the intestine where it is best absorbed.
C. Wait 2 hours after meals to take the tablet.This is the correct answer because iron is best absorbed on an empty stomach, typically one hour before or two hours after meals. Food can interfere with the absorption of iron, so waiting ensures better efficacy of the supplement.
D. Take the tablet with a daily multivitamin.Taking iron with a multivitamin can be problematic because certain minerals in multivitamins, such as calcium, can inhibit iron absorption. It is better to take iron supplements separately to maximize absorption.
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