The nurse is administering a vancomycin infusion.

What measure should the nurse implement to reduce complications that may occur with this drug’s administration?

Choice A rationale
A client with a hip fracture and is on bedrest for 4 weeks may indeed experience constipation due to decreased physical activity. However, this situation would not necessarily require the nurse to question the order for psyllium. Psyllium is a bulk-forming laxative that can help relieve constipation by increasing stool bulk and improving bowel regularity.
Choice B rationale
Morphine is an opioid medication that can cause constipation as a side effect. Therefore, a client who is experiencing severe pain and is prescribed morphine may benefit from a laxative like psyllium to help manage opioid-induced constipation. This situation would not necessarily require the nurse to question the order for psyllium.
Choice C rationale
A client who is post-operative and is on a clear liquid diet may experience constipation due to the low fiber content of the diet. However, this situation would not necessarily require the nurse to question the order for psyllium. Once the client progresses to a regular diet, psyllium can help add bulk to the stool and promote regular bowel movements.
Choice D rationale
This choice is correct. A client with a recent stroke who has difficulty swallowing may be at risk for aspiration, or the inhalation of food or liquid into the lungs, when taking psyllium. Psyllium is a bulk-forming laxative that absorbs water in the intestines to form a softer, bulkier stool. If a client with swallowing difficulties were to aspirate the psyllium, it could potentially expand in the lungs when it comes into contact with moisture, leading to serious complications. Therefore, the nurse should question the order for psyllium in this situation.

Choice A rationale
When a patient is administering both regular insulin and NPH insulin, it’s important to draw up the regular insulin first. This is because regular insulin is clear and NPH insulin is cloudy. If the NPH (cloudy) insulin were drawn up into the syringe first, it could contaminate the regular (clear) insulin when drawing it up second. This could affect the action of the regular insulin, which is meant to be fast-acting.
Choice B rationale
Mixing insulins in a vial before drawing them up is not recommended. This could lead to inaccurate dosing and potential contamination of one or both vials. It’s safer and more accurate to draw up each type of insulin separately into the syringe.
Choice C rationale
While it’s possible to administer insulin using separate syringes, it’s usually not necessary and can be more cumbersome for the patient. As long as the patient is careful to avoid contaminating the insulins and to draw them up in the correct order (regular before NPH), they can be administered together in the same syringe.
Choice D rationale
Drawing up the NPH insulin last is not correct. As mentioned earlier, the regular insulin should be drawn up first to avoid contaminating it with the NPH insulin.