A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.).

Choice A rationale:
Limiting dietary intake of salt prior to menses can help reduce fluid retention and breast swelling, thus minimizing discomfort.
Choice B rationale:
Taking tub baths doesn’t necessarily minimize discomfort associated with FBC. Hot water running over the breast tissue doesn’t have a significant impact on FBC symptoms.
Choice C rationale:
Removing the bra at night might provide some relief but it’s not a primary strategy for minimizing discomfort in FBC.
Choice D rationale:
Reducing fluid intake to 1 liter per day during menstruation is not recommended. Adequate hydration is important for overall health.

The correct answer is choice B. Inject 20 units of air into the NPH insulin vial.

Choice A rationale:

Replacing the needle for withdrawal with a safety needle is an important step to ensure safety and prevent needle-stick injuries. However, this action is not the first step when mixing two types of insulin. The initial steps involve preparing the insulin vials by injecting air into them.

Choice B rationale:

Injecting 20 units of air into the NPH insulin vial is the correct first step. This is because NPH insulin is a suspension and needs to be mixed properly. Injecting air into the vial helps to equalize the pressure, making it easier to withdraw the correct amount of insulin later. This step is crucial to ensure accurate dosing and proper mixing of the insulin.

Choice C rationale:

Injecting 10 units of air into the regular insulin vial is also necessary, but it is not the first step. The correct sequence is to first inject air into the NPH insulin vial, then into the regular insulin vial. This order helps prevent contamination of the regular insulin with NPH insulin.

Choice D rationale:

Withdrawing 10 units of insulin from the regular insulin vial is an important step, but it should be done after injecting air into both vials. The correct sequence ensures that the insulin is mixed properly and that the doses are accurate.

By following these steps in the correct order, the nurse ensures that the insulin is mixed safely and effectively, minimizing the risk of errors and ensuring proper glycemic control for the patient.