A nurse is monitoring a client in a cardiac care unit.

Exhibits

A nurse is educating a client on the mechanism of action of ACE inhibitors, such as Lisinopril. Which of the following statements about ACE inhibitors mechanism of action and their therapeutic effects is accurate?

A. Shake the NPH insulin until it is well mixed: NPH insulin should be gently rolled between the palms, not shaken vigorously, to avoid creating bubbles and affecting its potency. Gentle mixing ensures proper suspension without compromising the insulin.

B. Draw up the NPH insulin into the syringe first: The correct technique is to draw up regular (clear) insulin first, followed by NPH (cloudy) insulin, to prevent contaminating the regular insulin with the longer-acting NPH. Drawing NPH first can alter the regular insulin’s action.

C. Inject air into the regular insulin first: Injecting air into both insulin vials before drawing up doses equalizes pressure and facilitates accurate measurement. Air is injected first into the regular insulin vial to maintain proper technique when mixing insulins.

D. Discard regular insulin that appears cloudy: Regular insulin is a clear solution. Cloudiness indicates contamination or expiration, so cloudy regular insulin should never be used. This instruction reinforces proper medication safety practices.

Rationale for correct choices:

• Heart rate 102/min: Tachycardia may indicate dehydration from diarrhea, fever, or early sepsis. The nurse should monitor trends, assess for other signs of fluid deficit, and notify the provider if it worsens.
• Temperature 38.9°C (102°F): Fever indicates infection, consistent with C. difficile. This requires monitoring, infection control measures, and potential initiation or adjustment of antibiotic therapy as prescribed.
• Hyperactive bowel sounds: Increased bowel activity reflects ongoing diarrhea and gastrointestinal irritation from the infection. Monitoring bowel frequency and character helps assess severity and guides fluid and electrolyte replacement.
• Potassium 3.3 mEq/L: Hypokalemia is a significant electrolyte disturbance caused by diarrhea. It increases the risk for cardiac dysrhythmias, muscle weakness, and requires prompt intervention such as potassium replacement and provider notification.

Rationale for incorrect choices:

• Abdomen soft, nondistended: While the client has diarrhea, a soft, nondistended abdomen is a normal finding and does not require immediate corrective action.
• Hematocrit 47% / Hemoglobin 16 g/dL: These values are at the upper normal limits but do not indicate acute problems and do not require immediate follow-up.