N368 Final Chapters 44 Insulin NCLEX

Question 1

A client receives NPH (Isophane) insulin at 0730. Based on an understanding of peak time, the nurse should assess the client for hypoglycemia at what time? Write your an- swer below.

Answer 1

Answer: 1600
Rationale: The onset of NPH is between 1 and 4 hours, and it peaks between 8 and 12 hours. Cognitive Level: Application. Nursing Process: Assessment. Client Need: Physiological Integrity.

Question 2

The client is scheduled to receive 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. What nursing intervention is most appropriate for this client?
1. Make sure the client’s breakfast is ready to eat before ad- ministering this insulin.
2. Offer the client a high-carbohydrate snack in 6 hours.
3. Hold the insulin if the blood glucose level is greater than
100 mg/dl.
4. Administer the medications in two separate syringes.

Answer 2

Answer 1
rationale: Humalog is a rapid-acting insulin that is administered for ele- vated glucose levels and should be given 0 to 15 minutes before breakfast. Hypoglycemic reactions may occur rapidly if Humalog insulin is not sup- ported by sufficient food intake. The medication can be mixed in one sy- ringe. Cognitive Level: Application. Nursing Process: Implementation. Client Need: Physiological In tegrity.

Question 3

The nurse is initiating discharge teaching with the newly diagnosed diabetic. Which of the following statements indicates that the client needs additional teaching?
1. “If I am experiencing hypoglycemia, I should drink 1/2 cup of apple juice.”
2. “My insulin needs may increase when I have an infection.”
3. “I must draw the NPH insulin first if I am mixing it with
regular insulin.”
4. “If my blood glucose levels are >300mg/dl, I must check
my urine for ketones.”

Answer 3

Answer: 3
Rationale: Additional teaching is needed. The clear solution (regular insulin) should be drawn into the syringe first followed by the cloudy solution (NPH). The other options demonstrate an understanding of discharge instructions. Cognitive Level: Analysis. Nursing Process: Evaluation. Client Need: Physiological Integrity.

Question 4

What client education should the nurse provide to the di- abetic client who is planning an exercise program? (Select all that apply.)

1. Monitor blood glucose levels before and after exercise.
2. Eat a complex carbohydrate prior to strenuous exercise. 3. Exercise may increase insulin needs.
3. Withhold insulin prior to engaging in strenuous exercise. 5. Take extra insulin prior to exercise.

Answer 4

Answers: 1> 2> 3, 4
Rationale: The client needs to understand that exercise may increase insulin needs. Blood glucose levels should be monitored prior to starting and after ending exercise, and addressed appropriately. A complex carbohydrate should be consumed prior to strenuous exer- cise. Cognitive Level: Analysis. Nursing Process: Implementation. Client Need: Physiological Integrity.

Question 5

During assessment, the client states, “My blood glucose levels range between 80 and lOOmg/dl, but my early morning blood glucose levels are 200 mg/dl.” This nurse explains that this phenomena is best known as which of the following?

1. Hyperosmolarity
2. Somogyi phenomenon 3. Insulin resistance
3. Diabetic ketoacidosis

Answer 5

Answer: 2
Rationale: Somogyi phenomenon occurs when there is a rapid drop in blood glucose levels during the night, which stimulates the release of blood glucose-elevating hormones. The result is an elevated morn- ing glucose level. Insulin resistance occurs when the body is unable to adequately utilize the insulin it produces. Diabetes ketoacidosis oc- curs when the blood sugar is elevated and the body is producing ke- toacids. Hyperosmolarity occurs with elevated blood glucose levels. Cognitive Level: Analysis. Nursing Process: Implementation. Client
Need: Physiological Integrity.

Question 6

A 28-year-old woman who is pregnant with her first child is diagnosed with gestational DM. She is concerned about the fact that she might have to take “shots.” She tells the nurse at the public health clinic that she doesn’t think she can self-administer an injection and asks if there is a pill that will control her blood sugar. She has heard her grand- father talk about his pills to control his “sugar” What should the nurse explain to this client?

Answer 6

The nurse should first explain that management of type 1 dia- betes is initiated with diet, exercise, and home blood glucose moni- toring. Compliance with prescribed regimens may reduce the client s fasting and postprandial blood glucose values to acceptable levels. Mothers with type 1 diabetes must keep their blood glucose level within a very narrow range to prevent the numerous complications that can occur because of elevated blood glucose during pregnancy. These complications can range from fetal deformity to fetal macrosomia and its subsequent sequelae. Some authorities recommend that the fasting blood glucose levels be maintained at or below 100 mg/dl and the postprandial glucose below 120 mg/dl. The nurse should prepare the client for insulin therapy in case diet and exercise fail to maintain control. Oral hypoglycemic agents cross placental membranes and have been implicated as teratogenic agents. Their use is not recom-
mended during pregnancy.

Question 7

When reviewing a client’s insulin administration record, the nurse notes that the client is routinely rotating injection
EIPLOUE
4«.r«vff(»0 * MVny. tub Q

Answer 7

Absorption rates of subcutaneous insulin vary among various body areas. It is known that the abdomen has the fastest rate of absorption, followed by the arms, thighs, and buttocks. It is also generally ac- cepted that exercise of a body area can increase the rate of insulin ab- sorption. Rotating from arm, to leg, to abdomen for injections affects glucose control levels because of the variation in absorption rates. For this reason, systematic rotation within one area at a time is recom- mended. The nurse in this situation should review a correct system of
rotation for this client.

Question 8

The client has insulin glargine (Lantus) and regular insulin ordered for every morning. Explain the implications of administering these two types of insulins.

Answer 8

Insulin glargine (Lantus) is a newer agent that is a recombinant human insulin analog. It must not be mixed in the syringe with any other insulin and must be administered subcutaneously. Insulin glargine appears to have a constant long-duration hypoglycemic ef- fect with no defined peak effect. It is prescribed once daily, at bedtime. The nurse should question the order for Lantus to be administered every morning.