The practical nurse (PN) applies and then releases pressure to a client's fingernail as seen in the photo. Normal nail color returns in 2 seconds. Which action should the PN take?

The PN should double-check the following with a second nurse:

• The dose of insulin drawn up in the syringe: Double-checking the dose of insulin is essential to ensure the correct amount is being administered to the client.
• The insulin vial for color and clarity: Insulin should be clear and free of particles or discoloration. Checking the vial for any abnormalities ensures the integrity and quality of the insulin.
• The expiration date on the insulin vial: Insulin should not be used beyond its expiration date. Verifying the expiration date helps ensure that the insulin is still effective and safe for administration.
• The insulin concentration: Different concentrations of insulin are available, such as

U-100 and U-500. Double-checking the concentration ensures that the correct type of insulin is being administered.

It's important to note that the other options listed are not necessary for double-checking with a second nurse in this context:

• The sliding scale insulin lispro order: Sliding scale insulin is typically used to adjust insulin doses based on blood glucose levels. However, in this case, the given dose of 2 units of insulin lispro may be a specific prescription for the client's diabetes management and not related to the acute appendicitis.
• The type of insulin to be administered: The type of insulin, in this case, is specified as insulin lispro. Confirming the type of insulin is important, but it is not a part of the double-checking process since it is already specified.
• The history and physical with the diabetes diagnosis listed: The client's medical history and diabetes diagnosis are important aspects of their overall care but are not directly related to double-checking the administration of insulin.
• The site for insulin administration: The specific site for insulin administration may depend on the client's individual preference or medical condition, but it is not a part of the double-check process. The double-check is primarily focused on the accuracy of the medication itself.

This is the correct answer because it is the best way to assess for signs of ototoxicity, which is a potential adverse effect of aminoglycosides. Ototoxicity is the damage or injury to the inner ear or auditory nerve caused by certain drugs or chemicals. It can result in hearing loss, tinnitus, vertigo, or balance problems. Aminoglycosides are a class of antibiotics that are effective against gram-negative bacteria, but they can also cause ototoxicity by interfering with the function of the hair cells in the cochlea.

The practical nurse (PN) should monitor the client's hearing by asking about any changes in hearing acuity, ringing in the ears, or difficulty understanding speech. The PN should also perform a hearing test using a tuning fork or an audiometer if available. The PN should report any signs of ototoxicity to the healthcare provider and discontinue the aminoglycoside as ordered.