The nurse is providing discharge instructions for a client with metastatic cancer who is proscribed morphine for bone pain. Which information from the client indicates to the nurse an understanding of the medication?

A) Provide information on increasing medication dosage if ketoacidosis occurs: While it is important for clients with diabetes to understand the signs and symptoms of diabetic ketoacidosis (DKA) and how to respond, increasing insulin dosage on their own without healthcare provider guidance could be dangerous. Adjusting insulin dosage should always be done under the direction of a healthcare provider.

B) Teach the client self-injection skills for daily subcutaneous administration: Insulin glargine is a long-acting insulin used for basal (background) insulin coverage in clients with diabetes. Teaching the client how to self-administer insulin injections is essential for effective management of diabetes, especially when using long-acting insulin formulations like insulin glargine. Proper injection technique, site rotation, and storage of insulin are important aspects of this teaching.

C) Demonstrate how to select dose based on before meal blood sugar readings: Insulin glargine is typically administered once daily at the same time each day and is not adjusted based on before meal blood sugar readings. Instead, it provides a steady level of insulin over 24 hours to help control blood sugar levels between meals and overnight.

D) Explain to the family how to inject this medication for severe hypoglycemia: Insulin glargine is not used for the treatment of severe hypoglycemia. Instead, it is a long-acting insulin used to maintain basal insulin levels in clients with diabetes. Severe hypoglycemia is treated with fast-acting glucose sources such as oral glucose tablets, gel, or glucagon injections, and the family should be educated on these treatments instead.

A) CT scan that was performed six months earlier: A previous CT scan performed six months earlier does not necessarily require follow-up by the nurse. However, it would be important to review the results of the previous CT scan to compare findings and assess for any changes over time.

B) Takes metformin hydrochloride for type 2 diabetes mellitus: This is the correct answer. Metformin is excreted by the kidneys, and contrast media used in CT scans can potentially cause kidney damage, particularly in clients with pre-existing renal impairment. Therefore, clients taking metformin may be at increased risk of developing lactic acidosis if renal function is compromised. It is essential for the nurse to follow up on this information and coordinate with the healthcare provider to determine whether metformin should be temporarily discontinued before the CT scan and when it can be safely resumed.

C) Report of client’s sobriety for the last five years: The client’s sobriety status for the last five years is not directly relevant to the CT scan with contrast for evaluating pulmonary embolism. While substance use history is important for overall health assessment, it does not specifically require follow-up related to the CT scan.

D) Metal hip prosthesis was placed twenty years ago: The presence of a metal hip prosthesis placed twenty years ago may be relevant for certain imaging studies, such as magnetic resonance imaging (MRI) or metal artifact reduction sequence (MARS) MRI, but it is not directly related to the CT scan with contrast for pulmonary embolism evaluation. Therefore, it does not require immediate follow-up by the nurse in this context.