A client receives a prescription for methotrexate. Which information provided by the client requires additional instruction by the nurse?

A) Teach the client self-injection skills for daily subcutaneous administration: Insulin glargine is a long-acting insulin that is typically administered once daily via subcutaneous injection. Teaching the client how to properly administer insulin injections is crucial for managing type 2 diabetes effectively. Proper technique and routine are essential for ensuring correct dosing and preventing complications.

B) Demonstrate how to select dose based on before-meal blood sugar readings: Insulin glargine is not used for adjusting doses based on pre-meal blood sugar readings; it provides a steady baseline of insulin coverage throughout the day. Dose adjustments for type 2 diabetes are generally not based on meal-time glucose readings with long-acting insulin.
C) Explain to the family how to inject this medication for severe hypoglycemia: Insulin glargine is used to maintain long-term glucose control and is not typically used in emergency situations like severe hypoglycemia. Emergency treatment for severe hypoglycemia generally involves glucose administration rather than insulin injections.
D) Provide information on increasing medication dosage if ketoacidosis occurs: Insulin glargine is not adjusted based on acute conditions such as ketoacidosis. Management of diabetic ketoacidosis involves more immediate insulin and fluid management strategies, and dosage adjustments should be guided by a healthcare provider, not based on routine discharge instructions.

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary: A hematocrit of 43% is within the normal range, suggesting the client’s anemia is improving. If the hematocrit were still low, continuing daily injections would be appropriate, but this is not the case here.

B. Notify the healthcare provider of the client’s hematocrit level so the frequency of injections can be reduced: Since the hematocrit is normal, there is no need to notify the healthcare provider specifically for changing the injection frequency based solely on the hematocrit level. Reducing injection frequency should be based on the overall treatment plan and not just the current hematocrit.
C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition: While the medication may be effective, informing the client about the potential for less frequent injections could improve adherence and reduce discomfort, if the healthcare provider approves.
D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections: Teaching self-administration can empower the client and potentially reduce discomfort by allowing the client to become more comfortable with the process. It also offers the opportunity for the client to manage their injections more conveniently and with greater control.