A teenage client is taking duloxetine (Cymbalta) for a generalized anxiety disorder. The dose has been changed by the physician.
What adverse effects will the nurse advise the client and family to watch?

Choice A rationale
Taking less than the recommended dose initially may not provide the desired therapeutic effect and could lead to misunderstanding about the effectiveness of the herbal product.
Choice B rationale
While it’s true that some herbal products should not be taken with prescription medications due to potential interactions, this is not the best way to identify allergic or other adverse reactions.
Choice C rationale

While checking with a reputable pharmacist is always a good idea when starting any new medication or supplement, it is not the best way to identify allergic or other adverse reactions.
Choice D rationale
Using only one herbal preparation at a time is the best way to identify allergic or other adverse reactions. If multiple herbal products are started at the same time and an adverse reaction occurs, it would be difficult to determine which product caused the reaction.

Choice A rationale
The patient with a pre-meal glucose level of 90 mg/dL, scheduled to receive 10 units of NPH, is not in immediate need of insulin. NPH is an intermediate-acting insulin, and a glucose level of 90 mg/dL is within the normal range.
Choice B rationale

The patient with a pre-meal glucose level of 70 mg/dL, scheduled to receive 2 units of aspart (Novolog) insulin, is not in immediate need of insulin. A glucose level of 70 mg/dL is at the lower end of the normal range, and aspart is a rapid-acting insulin.
Choice C rationale
The patient with a pre-meal glucose level of 120 mg/dL, scheduled to receive 15 units of NPH, is not in immediate need of insulin. A glucose level of 120 mg/dL is slightly elevated, but NPH is an intermediate-acting insulin.
Choice D rationale
The patient with a pre-meal glucose level of 170 mg/dL, scheduled to receive 5 units of lispro (Humalog) insulin, should receive insulin first. A glucose level of 170 mg/dL is significantly elevated, and lispro is a rapid-acting insulin, making it the most appropriate choice for immediate administration.