A client is ordered to receive insulin lispro (Humalog) at mealtimes. When should the nurse instruct the client to administer the medication?

Choice A rationale:

Insulin glargine (Lantus) is a long-acting insulin analog that is designed to provide a steady, basal level of insulin throughout the day.

It has a duration of action of approximately 24 hours, so it is typically administered once daily at bedtime.

This helps to control blood glucose levels overnight and during the early morning hours, when the risk of hypoglycemia is highest.

Key characteristics of Insulin Glargine (Lantus):

Onset: 1-2 hours

Peak: No pronounced peak Duration: Approximately 24 hours

Administration: Once daily at bedtime

Choice B rationale:

Lispro (Humalog) is a rapid-acting insulin analog that is designed to be taken with meals to help control blood glucose spikes after eating.

It has a onset of action of approximately 15 minutes and a duration of action of 2-4 hours.

Because of its rapid onset and short duration of action, lispro is not typically used as a basal insulin. Key characteristics of Lispro (Humalog):

Onset: 15 minutes

Peak: 30-90 minutes

Duration: 2-4 hours

Administration: With meals

Choice C rationale:

Insulin detemir (Levemir) is another long-acting insulin analog that is similar to insulin glargine in terms of its duration of action.

It is typically administered once daily at bedtime to provide basal insulin coverage. Key characteristics of Insulin Detemir (Levemir):

Onset: 1-2 hours

Peak: No pronounced peak

Duration: Approximately 18-24 hours Administration: Once daily at bedtime Question 23.

The nurse receives an order for insulin: NPH (Humulin NPH) 10 units to be administered intravenously daily at 7:00am.

What action should the nurse take?

A. Administer the dose but ensure that if mixed with another Humulin-R insulin, to draw the regular insulin up first.

B. Give the drug subcutaneously rather than IV

C. Review the insulin order with the prescriber and pharmacy.

D. Administer the insulin ordered mixed in 50 ML of 0.9%NS IV Piggyback (not to infuse faster than 1/2 hour or 30 minutes).

The correct answer is C. Review the insulin order with the prescriber and pharmacy.

Rationale for Choice A:

Intravenous administration of NPH insulin is not recommended. It is an intermediate-acting insulin that is designed to be absorbed slowly from the subcutaneous tissue. IV administration can lead to rapid and unpredictable changes in blood glucose levels, which can be dangerous.

Mixing NPH insulin with regular insulin does not change the route of administration. Both insulins should still be given subcutaneously.

Rationale for Choice B:

Subcutaneous administration of NPH insulin is the correct route. This allows for slow and steady absorption of the insulin, which helps to prevent blood glucose fluctuations.

However, the nurse should still clarify the order with the prescriber and pharmacy. This is because IV insulin orders are unusual and may be a mistake.

Rationale for Choice D:

Adding NPH insulin to a 50 mL IV piggyback is not a safe practice. This would dilute the insulin and make it even more difficult to control the rate of infusion.

IV insulin infusions are typically administered using a dedicated insulin pump. This allows for precise control of the infusion rate and helps to prevent hypoglycemia.

Rationale for Choice C:

Reviewing the insulin order with the prescriber and pharmacy is the safest course of action. This will help to ensure that the order is correct and that the insulin is administered safely.

The prescriber may have meant to order regular insulin instead of NPH insulin. Regular insulin can be given intravenously, but it requires careful monitoring of blood glucose levels.

The pharmacy can also double-check the order and ensure that the correct insulin is dispensed.

Choice A Rationale:

NPH insulin can be mixed with certain other insulins, such as regular insulin, to achieve different effects and better control blood glucose levels. Therefore, stating that it should never be mixed with another insulin is incorrect.

Choice C rationale:

NPH insulin is an intermediate-acting insulin that can be administered at various times of the day, depending on the individual's needs and blood glucose patterns. It is not restricted to bedtime administration only.

Choice D rationale:

When mixing NPH insulin with another insulin, the order of mixing does not significantly affect its action. The crucial aspect is to ensure proper mixing of the insulins before administration.

Choice B rationale:

NPH insulin is a suspension, meaning the insulin particles are not fully dissolved in the liquid. Therefore, it's essential to roll the vial gently between the palms to evenly distribute the insulin particles throughout the solution. This ensures that the patient receives the correct dose and prevents injection of an uneven mixture, which could lead to unpredictable blood glucose levels.

Key points to remember:

NPH insulin is an intermediate-acting insulin that starts working within 1 to 2 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours.

It can be mixed with regular insulin to provide both short-acting and longer-acting insulin coverage. Always follow the specific instructions provided by the insulin manufacturer and healthcare provider. Proper mixing of NPH insulin is crucial for accurate dosing and optimal glucose control.