A nurse is providing teaching to a client who has diabetes mellitus. Which of the following instructions should the nurse provide to the client to help prevent the development of nephropathy?

Rationale:

A. Increase the oxygen flow rate by 1 L if the client experiences dyspnea: Oxygen therapy should be adjusted according to the prescribed rate by the healthcare provider. Dyspnea should be assessed, but changes in oxygen flow require professional supervision.

B. Replace cotton blankets with wool and synthetic blankets: Cotton is a safer material for individuals using oxygen therapy, as wool and synthetic fibers are more likely to generate static electricity, increasing the risk of fire. Cotton is less flammable and more appropriate.

C. Store oxygen tanks on their side when not in use: Oxygen tanks should be stored upright to ensure stability and prevent the valve from becoming damaged. Storing them on their side can lead to dangerous situations, such as the tank rolling or the valve being compromised.

D. Notify the fire department that oxygen is in use in the home: Notifying the fire department is an important safety measure when using oxygen therapy. Oxygen is highly flammable, and it is critical for the fire department to be aware of its presence in the home in case of an emergency.

Rationale:

A. "Initiate venous access with a 21-gauge needle." For blood transfusions, it is recommended to use a larger gauge needle, 18-20 gauge, to allow for proper blood flow and reduce the risk of hemolysis. A 21-gauge needle is too small for optimal transfusion.

B. "Obtain the client's first set of vital signs 1 hr after initiating the transfusion." The first set of vital signs should be obtained immediately before starting the transfusion, and then monitored every 15 minutes to detect any early signs of a transfusion reaction.

C. "Administer the unit of packed RBCs over 1 hr." The unit of packed RBCs should be administered over 4 hours to reduce the risk of transfusion reactions and allow for optimal oxygen-carrying capacity. Infusing blood too quickly can cause complications such as volume overload or reactions.

D. "Use Y tubing with 0.9% sodium chloride when administering the transfusion." Y tubing is commonly used for blood transfusions to allow for the infusion of normal saline (0.9% sodium chloride) alongside the blood product. This helps maintain the flow of the transfusion and reduces the risk of clot formation while flushing the line.