The nurse is aware that which insulins are long-acting and should be administered once daily at bedtime? (Select all that apply.)

Insulin glargine (Lantus)

Lispro (Humalog)

Insulin detemir (Levemir)

Answer and Explanation

Correct Answer : A,C

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.

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Correct Answer is B

Explanation

Choice A rationale:

Increasing the amiodarone infusion rate would worsen the patient's bradycardia and hypotension. Amiodarone is a class III antiarrhythmic drug that works by prolonging the action potential duration in cardiac cells. This can lead to a decrease in heart rate and contractility.

Increasing the dose in this patient could lead to further hemodynamic compromise.

Choice B rationale:

Decreasing the amiodarone infusion rate is the most appropriate action in this situation. This will help to mitigate the drug's effects on the patient's heart rate and blood pressure.

A dose reduction may allow the heart rate to recover to a safer level while still maintaining the antiarrhythmic benefits of amiodarone.

Choice C rationale:

Continuing the amiodarone infusion at the current rate is not appropriate, as it is likely to worsen the patient's bradycardia and hypotension.

Maintaining the current dose could lead to further clinical deterioration.

Choice D rationale:

Discontinuing the amiodarone infusion entirely may not be necessary at this point. The patient's arrhythmia may still require treatment with amiodarone.

A dose reduction may be sufficient to address the patient's hemodynamic instability while still providing therapeutic benefits.

A. Fava beans B. Shellfish C. Foods high in purine D. Grapefruit

Correct Answer is D

Explanation

Choice A rationale:

Fava beans do not interact with antithyroid medications and do not need to be avoided specifically for this reason. However, it's important to note that fava beans can cause a condition called favism in individuals with a certain genetic predisposition. Favism is characterized by hemolytic anemia, which is the breakdown of red blood cells. If a patient has a history of favism or is unsure of their risk, it's best to avoid fava beans while on antithyroid medication and consult with their healthcare provider.

Choice B rationale:

Shellfish does not typically interact with antithyroid medications. However, some individuals with hyperthyroidism may have co-existing allergies to shellfish. In those cases, it's important to avoid shellfish to prevent allergic reactions, but this is not due to a direct interaction with antithyroid medications.

Choice C rationale:

Foods high in purine, such as organ meats, red meat, and certain seafood, are often restricted in individuals with gout. Gout is a form of arthritis caused by the buildup of uric acid crystals in the joints. While hyperthyroidism can sometimes increase uric acid levels, there's no specific interaction between antithyroid medications and purine-rich foods. Therefore, avoiding purine- rich foods is not necessary for those on antithyroid therapy unless they have gout or a predisposition to it.

Choice D rationale:

Grapefruit and grapefruit juice can significantly interact with antithyroid medications, particularly methimazole and propylthiouracil. These medications are broken down by an enzyme called CYP3A4 in the liver. Grapefruit juice inhibits the activity of CYP3A4, which can lead to increased levels of antithyroid medications in the bloodstream. This can increase the risk of side effects from the medication, such as liver damage, bone marrow suppression, and skin reactions. Therefore, it's crucial for patients on antithyroid therapy to avoid grapefruit and grapefruit juice.

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The nurse is aware that which insulins are long-acting and should be administered once daily at bedtime? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A patient diagnosed with hyperthyroidism is about to start antithyroid medication therapy. Which food should the patient avoid as advised by the nurse?

Correct Answer is D

Explanation

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