A patient has been admitted with a fever of 102.8 F (39.3 C), with an unknown origin.

The patient’s urine is cloudy, foul-smelling, and dark amber.

Orders have been given to obtain urine and blood cultures immediately and to administer an antibiotic intravenously.

In what order should the nurse complete these orders?

Choice A rationale:

Insulin is not absorbed most rapidly when injected in the thigh. The abdomen is actually the preferred site for insulin injection as insulin is absorbed more quickly and predictably there. The thigh is a simple area for self-injection, but regular injections in the thigh can sometimes cause discomfort when walking or running afterward.

Choice B rationale:

Using cold insulin for injection to minimize site pain is not recommended. Insulin should be at room temperature. Cold insulin might make the injection more painful.

Choice C rationale:

Massaging the site after injection to promote absorption is not advised. It can cause the insulin to be absorbed too quickly which can lead to low blood glucose levels.

Choice D rationale:

Rotating the injection site to keep insulin levels consistent is the correct choice. People who take insulin daily should rotate their injection sites. This is important because using the same spot over time can cause lipodystrophy. In this condition, fat either breaks down or builds up under the skin, causing lumps or indentations that interfere with insulin absorption.

Choice A rationale:

Rifampin Rifampin is an antitubercular drug that is effective against all strains of Mycobacterium tuberculosis. It works by inhibiting the synthesis of RNA in the bacteria, preventing them from reproducing. However, it does not typically cause a decrease in visual acuity.

Choice B rationale:

Ethambutol Ethambutol is an antitubercular drug that can cause ocular toxicity in the form of visual field changes. It is known to induce toxic optic neuropathy, which is quite common and can lead to a decrease in visual acuity. Patients on Ethambutol therapy are advised to report any changes in visual acuity or eye discomfort immediately to their healthcare provider.

Choice C rationale:

Streptomycin Streptomycin is an aminoglycoside antibiotic used in the treatment of tuberculosis. It works by inhibiting protein synthesis in bacteria. While it can cause side effects such as ototoxicity and nephrotoxicity, it is not typically associated with a decrease in visual acuity.

Choice D rationale:

Isoniazid Isoniazid is a first-line antitubercular drug that works by inhibiting the synthesis of mycolic acids in the cell wall of Mycobacterium tuberculosis. While it can cause peripheral neuropathy, it is not typically associated with a decrease in visual acuity.