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 {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}
Explanation
Indicated Instructions:
-
Hold spironolactone for 3 days (Choice D):
-
Lay down if the blood pressure drops quickly after the first dose (Choice E):
Contraindicated Instructions:
-
Increase the lantus dose by 3 units the morning of the first dose (Choice B):
-
Limit fluids for several days before the first dose (Choice C):
-
Monitor blood pressure for several hours after the first dose (Choice B):
Correct Answer is C
Explanation
Choice A rationale; Family history of mental illness is important information to consider when assessing the client's overall mental health history, but it is not directly related to the immediate safety and effectiveness of duloxetine.
Choice B rationale: Weight change in the last month is relevant to monitoring for side effects of duloxetine, but it is not as critical as assessing liver function, which directly impacts the metabolism of the medication.
Choice C rationale: When planning care for a client starting on duloxetine, it is most important for the nurse to obtain liver function laboratory results. Duloxetine is primarily metabolized in the liver, and it is important to assess the client's liver function before starting the medication to ensure that the liver can process the drug effectively and safely. Clients with impaired liver function may require dose adjustments or be at higher risk for adverse effects, so obtaining liver function test results is crucial for safe medication management.
Choice D rationale: Recent use of other antidepressants is essential to avoid potential drug interactions, but it is not the most critical piece of information compared to assessing liver function, which directly affects the client's ability to process duloxetine.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.