At 0715, the client's blood glucose is 196. The physician orders include: Humulin R 4 units scheduled at 0730 along with a Medium Dose Sliding Scale of Humulin R as ordered below.

0-140 O units

141-190 4 units

191-240 6 units

241-340 8 units

+340 10 units and Consult primary physician

How many total units of insulin will the nurse administer this morning?

A. The client's heart rate falls to 65: A heart rate of 65 bpm may be within normal range, but it is not a specific indicator of ondansetron’s effectiveness. Ondansetron is an antiemetic, and its success is measured by reduction in nausea and vomiting, not changes in heart rate.

B. The client's systolic blood pressure lowers to 118: While 118 mm Hg is a normal systolic reading, ondansetron does not have a direct therapeutic effect on blood pressure. Blood pressure changes are not a reliable measure of antiemetic treatment success.

C. The client expresses hunger: Expressing hunger could suggest relief from nausea, but it is a subjective and indirect sign. A client may still feel nausea or be reluctant to eat for other reasons, so hunger alone does not confirm effectiveness of ondansetron.

D. The client is no longer vomiting: Ondansetron works by blocking serotonin receptors in the chemoreceptor trigger zone and gastrointestinal tract. Its primary purpose is to prevent or stop vomiting, making cessation of vomiting the most direct and reliable sign of effectiveness.

A. "The different onsets and peaks of the two types provide better overall glucose control.": Regular insulin has a rapid onset and short duration, while NPH insulin has a slower onset and longer duration. When used together, they mimic the body's natural insulin release pattern, offering both immediate and sustained glucose control throughout the day.

B. "NPH prevents regular insulin from being broken down in the body, allowing the use of a lower dose.": NPH does not alter how regular insulin is metabolized. Each insulin type acts independently, and NPH does not preserve or enhance the activity of regular insulin.

C. "The combination negates the risk of adverse effects that would likely accompany a single, larger dose.": The primary reason for using two types is to align insulin activity with the body’s varying needs. Risk reduction from side effects is not the primary purpose.

D. "NPH stimulates the pancreas to produce more insulin, while regular insulin provides your body's short-term needs.": NPH insulin is synthetic and does not stimulate pancreatic insulin production. Clients with type 1 diabetes lack insulin production altogether, so both types must be provided exogenously.