A patient with type I diabetes mellitus is scheduled for a total hip replacement and will be NPO after midnight.
The nurse noticed that the provider did not write an order to adjust the client’s daily insulin dose, which includes NPH and regular insulin.
What is the best action for the nurse to take?
Contact the provider for an order to decrease the morning insulin dose by half of the prescribed morning dose
Do nothing because the provider would want the client to receive the usual insulin dose prior to surgery
Notify the care provider who wrote the insulin order in the client’s medical record
Hold the morning dose of NPH and regular insulin until after a fasting glucose is done
The Correct Answer is C
Rationale for Choice A:
Decreasing the morning insulin dose by half without consulting the provider could lead to hyperglycemia, which can be dangerous for patients with diabetes, especially those undergoing surgery.
It is important to individualize insulin doses based on the patient's blood glucose levels, insulin sensitivity, and other factors. The provider may need to assess the patient's blood glucose levels and adjust the insulin dose accordingly.
Rationale for Choice B:
It is not safe to assume that the provider would want the client to receive the usual insulin dose prior to surgery without confirming this with the provider.
Patients with diabetes who are NPO (nothing by mouth) are at risk for hypoglycemia, as they are not receiving their usual intake of carbohydrates.
It is important to adjust insulin doses to prevent hypoglycemia in these patients.
Rationale for Choice D:
Holding the morning dose of insulin until after a fasting glucose is done could lead to hyperglycemia, as the patient would not be receiving any insulin to cover their blood glucose levels.
It is important to administer insulin to patients with diabetes, even if they are NPO, to prevent hyperglycemia.
Rationale for Choice C:
This is the best action for the nurse to take because it ensures that the provider is aware of the situation and can provide appropriate orders for the patient's insulin management.
The provider may need to adjust the insulin dose, order a fasting glucose level, or provide other instructions for the patient's care.
It is important to communicate with the provider to ensure that the patient receives safe and appropriate care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C"]
Explanation
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.
Correct Answer is C
Explanation
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin that does not have any immediate effect on blood glucose levels. It is not typically a concern for patients undergoing CT scans with contrast.
However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving insulin therapy, as the contrast media used in CT scans can sometimes cause hyperglycemia.
Choice B rationale:
Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing the absorption of carbohydrates from the intestines. This can help to reduce blood glucose levels after meals.
Acarbose is not typically a concern for patients undergoing CT scans with contrast. However, it is important to note that acarbose can sometimes cause gastrointestinal side effects, such as bloating, gas, and diarrhea. These side effects may be worsened by the contrast media used in CT scans.
Choice C rationale:
Metformin (Glucophage) is a biguanide that works by reducing glucose production in the liver and increasing insulin sensitivity in the muscles. It is a commonly used medication for the treatment of type 2 diabetes.
Metformin is a concern for patients undergoing CT scans with contrast because it can increase the risk of lactic acidosis. Lactic acidosis is a serious condition that can occur when there is a buildup of lactic acid in the blood. It can be caused by metformin, as well as by other factors such as dehydration, kidney problems, and liver problems.
The contrast media used in CT scans can also increase the risk of lactic acidosis. This is because the contrast media can sometimes cause kidney damage, which can impair the body's ability to remove lactic acid from the blood.
For this reason, metformin is typically discontinued for 48 hours before a CT scan with contrast. It is also important to ensure that patients are well-hydrated before and after the scan.
Choice D rationale:
Glipizide (Glucotrol) is a sulfonylurea that works by stimulating the release of insulin from the pancreas. It is a commonly used medication for the treatment of type 2 diabetes.
Glipizide is not typically a concern for patients undergoing CT scans with contrast. However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving sulfonylurea therapy, as the contrast media used in CT scans can sometimes cause hypoglycemia.
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