The nurse is instructing a patient on home administration of insulin.
The patient’s discharge instructions indicate that regular (Humulin R) and NPH (Humulin NPH) insulin should be administered at 0700 every day.
What is an important teaching point for this patient?
Draw up the medications after mixing them in a vial.
Inject the insulin into the buttocks only since this is a mixed insulin.
Draw up the NPH insulin first.
Draw up the regular insulin first.
The Correct Answer is D
Choice A rationale:
Mixing insulins in a vial is generally not recommended unless specifically instructed by the healthcare provider. It can alter the effectiveness of the insulins and increase the risk of dosage errors.
Premixed insulins, which are already combined in a specific ratio, are available if a combination of insulins is needed.
However, in this case, the patient is instructed to administer regular and NPH insulin separately, indicating that they should not be mixed in a vial.
Choice B rationale:
Insulin can be injected into various subcutaneous sites, including the abdomen, thighs, upper arms, and buttocks.
There is no specific requirement to inject mixed insulin into the buttocks only.
The choice of injection site can be based on individual preferences, absorption rates, and the presence of lipohypertrophy (thickening of the subcutaneous tissue due to repeated injections).
Choice C rationale:
Drawing up NPH insulin first could lead to contamination of the regular insulin vial with NPH insulin.
NPH insulin is a suspension, and drawing it up first could introduce some of its particles into the regular insulin vial, potentially altering its absorption and action profile.
Choice D rationale:
It's crucial to draw up the regular insulin first to prevent contamination of the regular insulin vial with NPH insulin. The following steps outline the correct procedure:
Wash hands thoroughly with soap and water.
Inspect the insulin vials for clarity, expiration date, and any damage.
Roll the NPH insulin vial gently between the palms to resuspend the insulin particles (if applicable). Wipe the rubber stoppers of both vials with an alcohol swab.
Using a sterile syringe, withdraw air into the syringe equal to the amount of regular insulin to be drawn.
Inject the air into the regular insulin vial, keeping the needle tip above the fluid level to avoid creating bubbles. Invert the regular insulin vial and withdraw the prescribed dose of regular insulin.
Without injecting air into the NPH insulin vial, withdraw the prescribed dose of NPH insulin. Administer the insulin as directed, using proper injection technique.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
NPH insulin is an intermediate-acting insulin that typically peaks 6-12 hours after administration.
Given that the insulin was administered at 1700 (5:00 PM), the peak action would be expected to occur between 2100 (9:00 PM) and 0500 (5:00 AM).
This time frame aligns with the known pharmacokinetics of NPH insulin.
It's crucial for nurses to be aware of the peak action times of different insulin types to effectively manage blood glucose levels and adjust insulin doses accordingly.
Choice B rationale:
Incorrect. NPH insulin does have a peak action, as explained above.
It's important to understand that even intermediate-acting insulins have a period of peak activity when they exert their strongest glucose-lowering effect.
Choice C rationale:
Incorrect. This time frame is too early to represent the peak action of NPH insulin. The peak action typically occurs later, between 6-12 hours after administration.
Choice D rationale:
Incorrect. This time point is too specific to accurately represent the peak action of NPH insulin.
The peak action can vary within the 6-12 hour window, depending on individual factors and injection site.
Correct Answer is A
Explanation
Choice A rationale:
Calcium gluconate is the antidote for magnesium sulfate toxicity. It directly counteracts the effects of magnesium on the neuromuscular system, cardiovascular system, and central nervous system. It is essential to have calcium gluconate readily available at the bedside of any client receiving magnesium sulfate, as toxicity can occur quickly and without warning.
Mechanism of action:
Calcium gluconate competes with magnesium for binding sites on cell membranes and proteins. It displaces magnesium from these sites, thereby restoring normal cellular function.
Calcium gluconate also enhances calcium influx into cells, which further counteracts the effects of magnesium. Indications for use in magnesium sulfate toxicity:
Respiratory depression (respiratory rate <12 breaths per minute) Loss of deep tendon reflexes
Seizures
Cardiac arrhythmias (including heart block and cardiac arrest) Hypotension (systolic blood pressure <90 mmHg)
Dosage and administration:
The typical dose of calcium gluconate for magnesium sulfate toxicity is 1 gram (10 mL of a 10% solution) given IV push over 3- 5 minutes.
This dose may be repeated as needed, depending on the severity of the toxicity and the client's response to treatment. Nursing considerations:
Monitor the client's vital signs, respiratory status, and deep tendon reflexes closely during magnesium sulfate infusion and after administration of calcium gluconate.
Have a crash cart and code equipment readily available in case of cardiac arrest. Document the administration of calcium gluconate and the client's response to treatment.
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