A nurse is reinforcing teaching about the use of an insulin aspart 70/30 pen with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

"I will hold the pen upside-down to select the appropriate dose."

"I will apply a disposable needle on the cartridge."

"I will aspirate before injecting the insulin."

"I will shake the pen before injecting the insulin."

Answer and Explanation

The Correct Answer is B

A. "I will hold the pen upside-down to select the appropriate dose.": Insulin pens are designed to be held upright with the needle pointing upward when selecting the dose. Holding it upside-down can cause air bubbles to enter the cartridge and result in inaccurate dosing. Correct technique ensures the client receives the intended insulin amount.

B. "I will apply a disposable needle on the cartridge.": Attaching a new disposable needle for each injection is essential to maintain sterility, prevent infection, and ensure accurate dosing. This practice also prevents needle damage and reduces the risk of insulin leakage during administration.

C. "I will aspirate before injecting the insulin.": Aspiration is unnecessary with subcutaneous insulin injections and can cause tissue trauma or discomfort. Current guidelines advise inserting the needle directly into subcutaneous tissue without pulling back to check for blood.

D. "I will shake the pen before injecting the insulin.": Shaking insulin aspart 70/30 can create air bubbles and compromise the insulin mixture. Instead, gently rolling the pen between the palms ensures proper mixing without introducing bubbles, preserving insulin effectiveness.

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Correct Answer is B

Explanation

A. Noticeable stool odor: Some odor is expected with normal colostomy output and can be managed with proper pouching and hygiene. This finding alone does not indicate a complication and typically does not require provider notification.

B. Purplish stoma: A purplish or dark-colored stoma may indicate compromised blood flow, ischemia, or necrosis, which is a medical emergency. Prompt reporting allows immediate assessment and intervention to prevent tissue death or further complications.

C. Slight bleeding around the stoma: Minor bleeding from the stoma or the surrounding skin can occur due to irritation or minor trauma during pouch changes. This is usually not urgent but should be monitored for worsening signs.

D. Soft, unformed stools: Variations in stool consistency are common after colostomy surgery, especially with diet changes. Soft stools are typically expected and do not signal a complication that requires immediate provider notification.

A. Supine with knees flexed B. Semi-Fowler's with legs extended C. Trendelenburg with legs extended D. Left-lateral with knees flexed

Correct Answer is A

Explanation

A. Supine with knees flexed: Positioning the client supine with knees flexed reduces strain on the abdominal muscles and incision site, helping prevent further protrusion of organs. This position also provides comfort and stabilizes the client while preparing for emergency surgical intervention. It minimizes tension on the wound during transport or care.

B. Semi-Fowler's with legs extended: Semi-Fowler's increases abdominal muscle tension, which can worsen evisceration and cause pain. Extending the legs further stretches the abdominal wall, increasing risk of organ protrusion. This position is not appropriate in cases of wound evisceration.

C. Trendelenburg with legs extended: Trendelenburg tilts the client’s head downward, which can increase intra-abdominal pressure and risk of further evisceration. Extended legs also increase tension on the incision.

D. Left-lateral with knees flexed: Lying on the left side may not adequately reduce abdominal pressure and can make access for emergency care more difficult. Although knees flexed help slightly, lateral positioning does not provide the same stability and protection as supine with knees flexed.

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A nurse is reinforcing teaching about the use of an insulin aspart 70/30 pen with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

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