A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if their blood glucose level is above 200 mg/dL. Which of the following information should the nurse include?
Discard the NPH solution if it appears cloudy.
NPH is an intermediate-acting insulin.
Freeze unopened insulin vials.
Shake the insulin vigorously before loading the syringe.
The Correct Answer is B
Choice A reason: This is incorrect because NPH insulin is normally cloudy and should be gently mixed before use. However, the nurse should discard the solution if it has clumps, flakes, or crystals.
Choice B reason: This is correct because NPH insulin is an intermediate-acting insulin that has a slower onset and longer duration than short-acting or rapid-acting insulins. The nurse should explain to the client that NPH insulin provides basal coverage and may need to be combined with other types of insulin to control blood glucose levels.
Choice C reason: This is incorrect because freezing insulin can damage its potency and effectiveness. The nurse should instruct the client to store unopened insulin vials in the refrigerator and opened vials at room temperature.
Choice D reason: This is incorrect because shaking insulin can cause air bubbles and frothing, which can affect the accuracy of the dose. The nurse should instruct the client to roll the insulin vial between the palms of the hands to mix it gently.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: Rotating the injection sites within the same location for a week is not correct. The client should rotate the injection sites within the same location each day to prevent lipodystrophy and ensure consistent absorption.
Choice B reason: Storing the unopened vials of insulin in the freezer is not correct. The client should store the unopened vials of insulin in the refrigerator, not the freezer, to prevent damage to the insulin.
Choice C reason: Drawing up the regular insulin before the NPH insulin is correct. The client should draw up the clear (regular) insulin before the cloudy (NPH) insulin to prevent contamination of the regular insulin with the NPH insulin.
Choice D reason: Injecting the insulin into the muscle for faster absorption is not correct. The client should inject the insulin into the subcutaneous tissue, not the muscle, to ensure appropriate absorption and prevent hypoglycemia.
Correct Answer is A
Explanation
The correct answer is a. Alcohol.
Choice A: Alcohol
Reason: Alcohol can significantly affect blood glucose levels in patients taking glimepiride. Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can occur depending on the amount and frequency of alcohol consumption. Alcohol can enhance the blood sugar-lowering effect of glimepiride, leading to a dangerous drop in blood sugar levels, known as hypoglycemia. Symptoms of hypoglycemia include dizziness, confusion, weakness, and in severe cases, loss of consciousness. Therefore, it is advised to avoid alcohol while taking glimepiride.
Choice B: Milk
Reason: There are no known interactions between glimepiride and milk. Milk does not affect the absorption or efficacy of glimepiride. Therefore, it is generally safe to consume milk while taking this medication.
Choice C: Grapefruit juice
Reason: Grapefruit juice might theoretically increase the levels of drugs metabolized by CYP2C9, including glimepiride, due to its potential to inhibit CYP2C9 enzymes. However, this interaction has not been reported in humans and is considered unlikely to have a significant clinical impact. Therefore, grapefruit juice is not a major concern for patients taking glimepiride.
Choice D: Coffee
Reason: Coffee and other caffeinated beverages may increase blood sugar levels, which can counteract the effects of glimepiride. However, this interaction is not as significant as the interaction with alcohol. It is generally advised to monitor blood sugar levels and consume coffee in moderation while taking glimepiride.
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