test 2

Question 1

Types of Insulin

Answer 1

Insulin is derived from animal or human and is clearly indicated on the label

Human insulin is indicated as recombinant DNA origin

It is the most common type of insulin on the market because it causes fewer reactions than insulin from animal sources

Question 2

Insulin Calculations

Answer 2

Insulin is ordered in units, measured in units and delivered in units

Insulin doses must be checked by two nurses

Only use an Insulin syringe to administer insulin

Question 3

There are three basic types and action times of insulin:

Answer 3

Rapid-Acting - Humalog (Lispro - fastest)
Short acting (R) (Regular)
Intermediate-Acting or Modified (N) (Lente, NPH)
Long-Acting or Modified - Ultra Lente (Lantus - longest acting)

Question 4

U-500 Insulin

Answer 4

500 units per mL
Indicated for clients with marked insulin resistance
Check insulin label carefully

If you have uncertainty, clarify it, NEVER ASSUME!
Check calculations and preparations with 2 nurses

Question 5

Alternate Delivery Devices

Answer 5

Insulin Pumps

• Delivery through a catheter placed under the skin
• Basal: delivered continuously
• Bolus: delivered before meals

Insulin Dial Up Pens

Question 6

Components of an Insulin order

Answer 6

1. Brand name of insulin
2. The dosage strength of the insulin
3. The number of units to be administered
4. The route (subcut or IV)
5. The time it should be given
   ie. Humulin R U-100 16 unit subcut ac

Question 7

Sliding Scale Insulin Orders

Answer 7

Sometimes in addition to standing insulin orders, clients may have orders for additional insulin to “cover” their increased blood sugar levels

Sliding scale indicates a certain dosage of insulin based on the client’s blood glucose level.

Regular insulin is used because it is fast acting and has a short duration (Lispro may be used if an ultra fast effect is required)

The dosage of insulin is determined by the blood glucose level

Question 8

Procedure for Mixing Two Types of Insulin in the Same Syringe

Answer 8

Sometimes individuals may require two different types of insulin for control of their blood sugar levels ie. NPH and Regular

To decrease the number of injections it is common to mix two insulin in one syringe

Check the medication order for the type and dose of each insulin

Check the label on each insulin bottle for the correct drug

Gently roll the longer-acting or modified (cloudy) insulin between the palms of your hand, (do not shake)

Clean the top of each insulin bottle with an alcohol swab.

Draw air into the syringe equal to the dose of the modified (longer-acting, cloudy) insulin

Insert the needle into the rubber stopper of the modified insulin vial and inject the air

Draw air into the syringe equal to the dose of the short-acting or Regular (clear) insulin

Insert the needle into the rubber stopper of the Regular (clear) insulin vial and inject the air

Turn the vial upside down and withdraw the dose of Regular insulin

Co-signature by the second nurse

Withdraw the needle

Insert the needle into the modified or longer-acting (cloudy) insulin bottle, turn the bottle upside down and slowly withdraw the dose

Ensure the correct dose is withdrawn so as not to contaminate the insulin

The volume in the syringe should now equal the combined dose of the Regular and the modified insulin

Co-signature by the second nurse

Question 9

Some medications must be stored in powered form to:

Answer 9

Maintain stability

Maintain potency

Question 10

Basic Principles for Reconstitution

Answer 10

1. Manufacturer provides directions
   • Including diluent amount in mL, storage instructions, dosage strength after reconstitution
   • Use correct amount of diluent
2. Diluents—Check expiration dates before use!
   • Most common—sterile water, normal saline, bacteriostatic water
3. Must identify the following information:
   • Type and amount of diluent
   • Expiration period after admixture
4. After reconstitution of a multi-dose vial LABEL the vial:
   • Date and time prepared, dosage strength, expiration date
   • Storage instructions (e.g., “refrigerate” )
   • Nurse’s initials
   • Apply label so that medication information is visible
5. The concentration of new mixture MUST be on the label (500 mg/mL)

Question 11

Displacement

Answer 11

After the diluent is added to the powdered medication it may yield more volume.

Some drugs may completely dissolve and there is no additional volume added.

Some powdered drugs take up space as it dissolves and results in an increase in the total amount of fluid after is it dissolved

This is referred to as “Displacement Factor or Displacement”
(e.g., volume of diluent is 2.5 mL and total volume of solution is 3 mL).

Question 12

round drug dosage

Answer 12

to the nearest tenth apart from specified drugs/circumstances (i.e. heparin, critical care drugs, pediatrics, oncology).

Question 13

Irrigating Solutions and Soaks

Answer 13

Nurses may need to dilute solutions such as hydrogen peroxide for topical solution
o Example: Prepare 180 mL of ¼ strength hydrogen peroxide solution diluted with NS
o Step 1: Desired solution strength ₓ amount of desired solution (mL) = x
¼ ₓ 180 mL = x mL
180 mL = x mL
4
x = 45 mL hydrogen peroxide
o Step 2: Ordered amount of solution – Solute = amount needed to dissolve solvent
180 mL – 45 mL = 135 mL
You would add 135 mL NS to 45 mL of hydrogen peroxide to made 180 mL of ¼ strength hydrogen peroxide

Question 14

IV = intravenous
IVP = intravenous piggy back
gtt = drops
Bolus = large amount of fluid as fast as possible
Infusion = to administer something into the patient
IV set = the tubing used for an IV infusion
AB = absorbed
RTBA = remaining to be absorbed
SBA = should be absorbed
TBA = to be absorbed

Answer 14

.

Question 15

Sites—

Answer 15

peripheral or central
Peripheral: hand, forearm, scalp, and rarely leg
Central: subclavian, PICC

Question 16

primary and secindary line

Answer 16

Primary line
Carries main IV solution; is continuous
May have additives such as potassium or vitamins
Secondary Line
Usually connected to primary
Contains solutions of smaller volume with medications
Usually intermittent (IVPB)

Question 17

Example: D5W or 5%

Answer 17

dextrose in water = 5 g dextrose per 100 mL

Question 18

NS AND 1/2 NS

Answer 18

Sodium chloride 0.9% (0.9 g in 100 mL)

Sodium chloride 0.45% (0.45 g in 100 mL)

Question 19

D5W

Answer 19

Dextrose 5% in water ( 5 g in 100 mL)

Question 20

D5NS

Answer 20

Dextrose 5% (5 g in 100 mL) in 0.9% sodium chloride(0.9 g in 100 mL)

Question 21

MINI AND MACRO DRIP

Answer 21

Mini Drip (or micro drip):  60 gtt/mL (drop factor)
More drops per mL = finer control over delivery rate
Good for pediatrics, geriatrics, CV patients

Macro Drip: 10, 15, 20, and 30 gtt/mL (drop factor)
Good for all other patients

Question 22

IV Medication Orders

Answer 22

1. Name of IV solution
2. Name of medication to be added, if any
3. Amount (volume) to be administered
4. Time period during which IV is to be infused

Question 23

Calculating Hourly Rates mL/hour

Answer 23

Formula used to calculate hourly rates

Amt to be infused = mL/hr
Time (hours)

Answer should always be rounded to a whole number

or if its in mins (20 mins for exampls)
mL/hr = 50mL X 60min
20min

= 3000

Question 24

IV Flow Rate Calculation gtt/min

Answer 24

Volume of Fluid (must be in mL) X gtt Factor (gtt/mL)
(OVER)
(time in minutes) 60 minutes

Question 25

Recalculating IV Flow Rates

Answer 25

Flow rates on IV’s can change due to: Client changing position Tubing becomes kinked Nurses need to monitor IV therapy frequently Readjust rate if the IV is ahead or behind schedule The recalculated rate should not vary from the original rate by more than 25% Prior to making any changes to the IV rate: assess your patient, check the hospital/agency policy, and notify the prescriber as indicated

Question 26

Determine the % of Variation Between the New IV Rate and The Original Rate

Answer 26

New Rate in mL/hr – Original Rate in mL/hr (over) Original Rate in mL/hr

Question 27

Recalculating IV Flow Rates

Answer 27

One litre of D5W is ordered to infuse over 8 hours. The infusion is started at 0600hr. At 1000hr there are 700mL of fluid left to be absorbed. Tubing drop factor =10gtt/mL Determine if the IV is: Ahead of schedule? Behind schedule? On time?

Question 28

Recalculate the IV Flow Rate

Answer 28

To recalculate the IV flow rate, divide the volume remaining by the time remaining. In this case you have 700mL to be absorbed (remaining) and there are 4 hours left (time remaining in your shift). 700mL = 175mL/hr, therefore you would have to set the new 4 hr hourly rate to 175mL/hr to infuse the balance of the fluid in the specified timeframe.