A patient with diabetes has been administered 38 units of NPH insulin at 7:00 AM. By 1:00 PM, the patient has been away from the nursing unit for 2 hours and missed lunch while waiting for a chest X-ray.
What is the most appropriate action for the nurse to prevent hypoglycemia?
Request that if testing is further delayed, the patient will eat lunch first.
Plan to discontinue the evening dose of insulin.
Save the lunch tray for the patient’s later return.
Send a glass of orange juice to the patient in the diagnostic testing area.
The Correct Answer is A
Choice A rationale:
Requesting that the patient eat lunch first if testing is further delayed is the most appropriate action to prevent hypoglycemia for the following reasons:
1. Timing of NPH Insulin Peak:
NPH insulin is an intermediate-acting insulin with a peak action time of 4-12 hours after administration.
In this case, the patient received NPH insulin at 7:00 AM, meaning its peak effect is likely to occur between 11:00 AM and 5:00 PM.
Delaying lunch beyond 1:00 PM significantly increases the risk of hypoglycemia as the insulin's action peaks without adequate food intake to balance glucose levels.
2. Ensuring Consistent Mealtimes:
Consistency in meal timing is crucial for managing blood glucose levels in diabetic patients. Delaying meals can disrupt the balance between insulin and glucose, leading to hypoglycemia.
Prioritizing lunch at the usual time, even amidst testing delays, helps maintain a more predictable glucose pattern.
3. Addressing Acute Hypoglycemia Risk:
Hypoglycemia is a serious complication of diabetes that can occur if blood glucose levels fall too low. Symptoms can include shakiness, sweating, dizziness, confusion, and even loss of consciousness.
Promptly addressing potential delays in food intake is essential to prevent hypoglycemia and its associated risks.
Rationales for other choices:
Choice B: Discontinuing the evening dose of insulin does not address the immediate risk of hypoglycemia due to the missed lunch. It could lead to hyperglycemia later in the day or overnight.
Choice C: Saving the lunch tray for later may not be feasible if testing is significantly delayed. It also does not prevent hypoglycemia in the immediate timeframe.
Choice D: While a glass of orange juice can provide a quick source of glucose, it is a short-term solution and does not replace a balanced meal. It could also lead to a rapid rise in blood glucose followed by a subsequent drop.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Calcitonin (Fortical) is a hormone that lowers blood calcium levels. It is not indicated for the treatment of hypocalcemia caused by parathyroid hormone deficiency. In fact, it could worsen the condition by further reducing calcium levels.
Calcitonin is primarily used to treat hypercalcemia (high calcium levels) and osteoporosis.
It works by inhibiting osteoclast activity, which reduces bone resorption and calcium release into the bloodstream.
Choice B rationale:
Calcium is the essential mineral for treating hypocalcemia. It directly replenishes calcium levels in the blood.
Calcium can be administered orally (PO) or intravenously (IVPB), depending on the severity of the hypocalcemia and the patient's condition.
Oral calcium is often preferred for mild to moderate hypocalcemia, while IV calcium is typically used for severe hypocalcemia or when rapid correction is necessary.
Calcium supplements are available in various forms, including calcium carbonate, calcium citrate, and calcium gluconate. The dosage of calcium will be individualized based on the patient's serum calcium levels and clinical response.
Choice C rationale:
Vitamin B12 is not directly involved in calcium regulation. It is essential for red blood cell production and nerve function. While vitamin B12 deficiency can sometimes be associated with hypocalcemia, it is not a primary treatment for this condition. Choice D rationale:
Vitamin D3 (Calcitriol) is a hormone that aids in calcium absorption from the intestines. It is often used in conjunction with calcium supplements to treat hypocalcemia.
However, vitamin D3 alone is not sufficient to treat hypocalcemia caused by parathyroid hormone deficiency. Parathyroid hormone is essential for activating vitamin D3 in the kidneys, so its deficiency limits the effectiveness of vitamin D3.
Correct Answer is B
Explanation
Choice A rationale:
Digoxin is a cardiac glycoside, not a calcium channel blocker. It works by increasing the force of contraction of the heart muscle and slowing the heart rate. However, it is not typically used as a first-line treatment for tachycardia. It's more commonly used to treat heart failure and atrial fibrillation.
Mechanism of action: Digoxin inhibits the sodium-potassium ATPase pump in cardiac cells, leading to an increase in intracellular calcium. This increased calcium availability enhances myocardial contractility. Digoxin also indirectly affects the autonomic nervous system, leading to a decrease in heart rate.
Key points:
Digoxin is not a calcium channel blocker.
It's used primarily for heart failure and atrial fibrillation.
Its mechanism of action involves increasing intracellular calcium and decreasing heart rate.
Choice B rationale:
Diltiazem (Cardizem) is a calcium channel blocker that is commonly used to treat tachycardia and manage heart rate. It works by blocking the movement of calcium into cardiac cells, which slows down the electrical conduction system of the heart and leads to a decrease in heart rate.
Mechanism of action: Diltiazem blocks L-type calcium channels in cardiac and vascular smooth muscle cells. This reduces calcium influx, leading to:
Decreased myocardial contractility Vasodilation (relaxation of blood vessels)
Negative chronotropic effect (decreased heart rate)
Negative dromotropic effect (slowed conduction through the AV node) Key points:
Diltiazem is a calcium channel blocker.
It's effective in treating tachycardia and managing heart rate.
Its mechanism of action involves blocking calcium channels, leading to various cardiovascular effects.
Choice C rationale:
Nitroglycerin is a vasodilator, not a calcium channel blocker. It works by relaxing the smooth muscle in blood vessels, which widens the vessels and allows more blood to flow through them. This can help to relieve chest pain (angina) and lower blood pressure, but it does not directly affect heart rate.
Mechanism of action: Nitroglycerin is metabolized to nitric oxide, which activates guanylate cyclase, leading to increased production of cyclic guanosine monophosphate (cGMP). cGMP causes smooth muscle relaxation, resulting in vasodilation.
Key points:
Nitroglycerin is a vasodilator, not a calcium channel blocker. It's primarily used for angina and hypertension.
Its mechanism of action involves nitric oxide-mediated vasodilation.
Choice D rationale:
Nitroprusside (Nipride) is a potent vasodilator, not a calcium channel blocker. It is typically used in critical care settings to manage severe hypertension or heart failure. It works by relaxing the smooth muscle in blood vessels, which widens the vessels and allows more blood to flow through them. This can help to lower blood pressure, but it does not directly affect heart rate.
Mechanism of action: Nitroprusside directly releases nitric oxide, leading to vasodilation. Key points:
Nitroprusside is a potent vasodilator, not a calcium channel blocker.
It's used in critical care settings for severe hypertension or heart failure.
Its mechanism of action involves direct nitric oxide release and vasodilation.
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