A nurse is reinforcing teaching about disease management with the parent of a school-age child who has ADHD. Which of the following information should the nurse include? (Select all that apply.)

A. "You should chill your medication before administration." Insulin should not be chilled before administration. It should be stored in a cool place, but administering insulin directly from the refrigerator can cause discomfort.

B. "You should rotate sites when administering the medication." Rotating injection sites helps prevent tissue damage and the formation of lumps or scar tissue. It is recommended to rotate sites within the same area (e.g., abdomen, thigh, etc.) to ensure absorption and prevent complications.

C. "You should administer your medication at a 45-degree angle." Insulin should generally be administered at a 90-degree angle for subcutaneous injection, not a 45-degree angle. A 45-degree angle may be appropriate.

D. "You should administer your insulin into a muscle." Insulin should be administered subcutaneously (into the fat layer just under the skin), not into the muscle. Injecting insulin into a muscle can alter its absorption rate and may cause irritation or pain.

Rationale for Correct Choice:

• Ceftriaxone: The child has an allergy to cephalosporins, which includes ceftriaxone. Since ceftriaxone is a cephalosporin antibiotic, it would be crucial for the nurse to clarify this prescription to avoid an allergic reaction.
• Medication allergy: The child’s medical history includes an allergy to cephalosporins, and ceftriaxone is a cephalosporin. Administering ceftriaxone to a child with this allergy could lead to an anaphylactic reaction or other serious adverse effects.

Rationale for Incorrect Choices:

• Ondansetron: Ondansetron is an antiemetic used for vomiting, and there is no evidence in the child’s history to suggest that this medication is contraindicated. The prescription for ondansetron does not require clarification based on the child's condition.
• Methylprednisolone: Methylprednisolone is a corticosteroid used to reduce inflammation. While it’s important to monitor the child for potential side effects, there is no indication that this medication would be contraindicated based on the child's condition.
• Budesonide: Budesonide is a corticosteroid inhaler commonly used for asthma or wheezing. There is no indication that this medication should be clarified as it’s appropriate for the child’s symptoms of wheezing and pneumonia.
• Albuterol nebulizer solution: Albuterol is a bronchodilator used to treat wheezing and bronchospasm. There is no indication that this medication needs clarification, as it is appropriate for the child’s respiratory symptoms.
• Vital signs: While the child’s vital signs show an elevated heart rate and respiratory rate, they do not provide a reason to clarify a medication prescription. These vital signs are likely a result of the infection and fever rather than an issue that affects medication choices.
• WBC count: The WBC count is mildly elevated, which is consistent with infection, but there is no reason to question medication orders based solely on this result. It does not affect the choice of antibiotics or other prescribed treatments.
• Scheduled chest x-ray: The scheduled chest x-ray is a part of the diagnostic process and does not impact the prescription of medications. It does not need to be clarified with respect to the medications ordered.
• Sodium level: The sodium level is within the normal range, so there is no need to clarify medication prescriptions based on this finding. It does not influence medication choices directly.