A nurse is providing teaching to a client who reports smoking 3 packs of cigarettes per day and has a prescription for nicotine gum. Which of the following instructions should the nurse include in the teaching?

C. Similar to regular insulin, injecting air into the NPH insulin vial helps maintain proper pressure and facilitates accurate withdrawal of the desired dose. Injecting air into the NPH vial ensures that the insulin can be withdrawn smoothly and accurately, avoiding any potential complications in mixing or administration.

A. Before withdrawing insulin from a vial, it's standard practice to inject air into the vial to equalize the pressure and facilitate smooth withdrawal of the desired dose. Injecting air into the regular insulin vial allows for easy withdrawal of the correct amount of insulin without creating a vacuum that could hinder accurate measurement.

B. NPH insulin is cloudy and needs to be gently agitated (rolled between palms) to ensure uniform suspension before withdrawal. Drawing NPH insulin first ensures that any insulin adhering to the needle from the regular insulin does not contaminate the NPH insulin vial. This sequence helps maintain the proper concentration of each insulin type.

D. After injecting air into the regular insulin vial, the nurse should withdraw the appropriate amount of regular insulin from the vial. Drawing regular insulin after NPH insulin ensures that the two types of insulin do not mix prematurely in the syringe, which could alter their pharmacokinetics and efficacy.

C. Thiazide diuretics like hydrochlorothiazide can cause orthostatic hypotension, which may contribute to the client's symptoms of dizziness and light-headedness upon standing. Advising the client to change positions slowly can help mitigate these symptoms by allowing the body time to adjust to changes in posture and blood pressure.
D. Thiazide diuretics can alter electrolyte levels, including potassium, which is critical for normal cardiac function. Although the client's potassium level (3.4 mEq/L) is within the normal range, ongoing

monitoring for potential dysrhythmias is prudent due to the electrolyte-altering effects of hydrochlorothiazide.
E. Given the client's report of dizziness and light-headedness upon standing, checking for orthostatic hypotension is important. Thiazide diuretics can cause volume depletion and subsequent orthostatic hypotension, especially in older adults. Assessing blood pressure and symptoms in supine and standing positions will help evaluate for orthostatic changes.
A. This is not typically recommended for hydrochlorothiazide. It is usually advised to take this medication in the morning to avoid nighttime diuresis and nocturia. Therefore, this action is not appropriate.
B. Hydrochlorothiazide is a thiazide diuretic that can cause potassium loss through increased urine output. Restricting potassium intake is not typically necessary unless potassium levels drop significantly below the normal range. Given that the client's potassium level is within the normal range (3.4 mEq/L), advising strict potassium restriction is not indicated at this time.