Nokea
A nurse is caring for a client who has developed a hypoglycemic reaction. Which of the following interventions should the nurse perform if swallowing and gag reflexes are present In the client?
- A. Administer glucagon by the parenteral route.
- B. Administer the insulin via insulin pump.
- C. Administer oral antidiabetics to the client.
- D. Give oral fluids or candy.
Correct Answer: D
Rationale: The nurse should administer oral fluids or candy to the hypoglycemic client with swallowing and gag reflexes. If the client is unconscious, the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump for diabetic clients who are pregnant or have had a renal transplant. Oral antidiabetic drugs are administered to clients with type 2 diabetes.
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A client receives insulin lispro at 8 a.m. The nurse would be alert for signs and symptoms of hypoglycemia at about which time?
- A. 8:15 a.m.
- B. 9 a.m.
- C. 10 a.m.
- D. 11 a.m.
Correct Answer: B
Rationale: Insulin lispro reaches its peak action in 30 minutes to 1.5 hours. Therefore, the client's greatest risk for hypoglycemia would be during this time or about 9 a.m. Onset of action occurs in 5 to 10 minutes, so the drug would begin being effective at this time.
The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. Which of the following would the nurse most likely give?
- A. Orange or other fruit juice
- B. Glucose tablets
- C. Insulin glargine (Lantus)
- D. Hard candy
- E. Insulin detemir (Levemir)
Correct Answer: A,B,D
Rationale: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10% or 50% IV.
When preparing to administer insulin glargine to a client, which of the following would be appropriate for the nurse to do?
- A. Check the expiration date on the vial.
- B. Shake the vial vigorously.
- C. Check the physician's orders for the type and dosage of insulin.
- D. Remove all air bubbles from the syringe barrel.
- E. Mix with short-acting insulin prior to administration.
Correct Answer: A,C,D
Rationale: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following preadministration steps: carefully check the physician's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, gently tilt end to end before withdrawing the insulin, and remove all air bubbles from the syringe barrel. The nurse should never mix or dilute insulin glargine (Lantus) with any other insulin or solution because the insulin will not be effective.
A nurse is assigned to administer insulin glargine to a client at a health care facility. What precaution should the nurse take when administering this drug?
- A. Administer glargine via IV route.
- B. Avoid mixing glargine with other insulin.
- C. Shake the vial vigorously before withdrawing insulin.
- D. Be sure the insulin has been refrigerated.
Correct Answer: B
Rationale: When administering insulin glargine to the client, the nurse should avoid mixing it with other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via the subcutaneous route once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end to end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if they are to be stored for about 3 months for later use.
As part of the ongoing assessment of a client receiving insulin detemir, the nurse would suspect that the insulin is not effective based on assessment of which of the following?
- A. Increased thirst
- B. Increased urination
- C. Increased appetite
- D. Confusion
- E. Abdominal pain
Correct Answer: A,B,E
Rationale: If the insulin was not effective, the client would exhibit signs and symptoms of hyperglycemia including drowsiness, dim vision, thirst, nausea, vomiting, abdominal pain, loss of appetite, acetone breath, and excessive urination.