A nurse is caring for a client in the ICU. The client's ECG monitor tracing reveals sinus bradycardia and ST-segment elevation. The client reports shortness of breath and feeling dizzy and faint. Which of the following medications should the nurse administer?

Choice A reason: Drawing the regular insulin into the syringe first is correct. When mixing two types of insulin, the clear (regular) insulin should be drawn up before the cloudy (NPH) insulin to prevent contamination.

Choice B reason: Storing prefilled syringes with the needle pointed upward can cause air bubbles to move into the insulin, which can alter the dose when injected. The needle should be pointed downward.

Choice C reason: Shaking the NPH vial vigorously is not recommended as it can create air bubbles and affect the insulin dose. Instead, the vial should be gently rolled between the hands to mix the insulin.

Choice D reason: Inserting the needle at a 15-degree angle is incorrect for subcutaneous injections. A 90-degree angle is typically used unless the patient is very thin, in which case a 45-degree angle may be used.

Choice A reason: Ocular irrigation should be performed from the inner corner (near the nose) toward the outer corner to avoid contaminating the other eye and to ensure that the flushing fluid and any chemical residue flow away from the unaffected eye. This method helps to minimize the risk of spreading the chemical to the other eye and allows for a more effective removal of the chemical from the affected eye.

Choice B reason: While positioning the client upright is correct, having the head turned toward the right side is not specifically recommended. The client should be positioned in a way that facilitates the flow of the irrigation fluid away from the unaffected eye, which typically means tilting the head to the side of the affected eye.

Choice C reason: Placing a strip of pH paper under the upper lid of the affected eye is done to measure the pH of the tear film and determine the acidity or alkalinity of the chemical involved. However, this is not an immediate action during the initial irrigation process. The first priority is to dilute and remove the chemical from the eye as quickly as possible.

Choice D reason: While sterile water can be used for ocular irrigation, it is not the first choice. The preferred solution for ocular irrigation is a saline solution or specific eye irrigating solutions because they are isotonic and less irritating to the eye tissues. Sterile water may cause discomfort due to its hypotonicity, which can lead to cellular swelling.