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A nurse prepares to administer insulin to a client at 1800. The client's medication administration record contains the following information: Insulin glargine: 12 units daily at 1800, Regular insulin: 6 units QID at 0600, 1200, 1800, 2400. Based on the client's medication administration record, which action should the nurse take?
- A. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.
- B. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin.
- C. Draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together.
- D. Inject first the glargine and then the regular insulin right afterward.
Correct Answer: A
Rationale: Insulin glargine cannot be mixed with other insulins. Administering glargine first, followed by regular insulin as separate injections, is correct to avoid mixing and ensure proper action.
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A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education?
- A. Test your urine daily for ketones.
- B. Use only buffered insulin in your pump.
- C. Store the insulin in the freezer until you need it.
- D. Change the needle every 3 days.
Correct Answer: D
Rationale: Changing the needle every 3 days reduces infection risk with insulin pumps. Testing urine for ketones, using buffered insulin, or freezing insulin are not recommended practices.
A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately?
- A. Serum chloride level of 98 mmol/L.
- B. Serum calcium level of 8.8 mg/dL.
- C. Serum sodium level of 132 mmol/L.
- D. Serum potassium level of 2.5 mmol/L.
Correct Answer: D
Rationale: Insulin promotes potassium movement into cells, risking hypokalemia (2.5 mmol/L is low). This requires immediate intervention to prevent complications like arrhythmias. The other values are near normal and not directly related to insulin therapy.
A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, 'Can I ask my niece to prefill my syringes and then store them for later use when I need them?' How should the nurse respond?
- A. Yes, prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up.
- B. Yes, syringes can be filled with insulin and stored for a month in a location that is protected from light.
- C. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes.
- D. No, insulin syringes cannot be prefilled and stored for any length of time outside of the container.
Correct Answer: A
Rationale: Insulin in prefilled plastic syringes is stable for up to 3 weeks when refrigerated, stored vertically with the needle up to prevent clogging. The other options are incorrect regarding storage duration, material, or stability.
A nurse is teaching a client with diabetes mellitus who asks, 'Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?' How should the nurse respond?
- A. Glucose is the only fuel used by the body to produce the energy that it needs.
- B. Your brain needs a constant supply of glucose because it cannot store it.
- C. Without a minimum level of glucose, your body does not make red blood cells.
- D. Glucose in the blood prevents the formation of lactic acid and prevents acidosis.
Correct Answer: B
Rationale: Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse should educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not directly involved in the production of red blood cells. Glucose in the blood does not directly prevent lactic acid formation.
A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has a capillary blood glucose of 33 mg/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first?
- A. Administer 1 mg of intramuscular glucagon.
- B. Encourage the client to drink orange juice.
- C. Insert a new intravenous access line.
- D. Administer 25 mL dextrose 50% (D50) IV push.
Correct Answer: A
Rationale: The client's severe hypoglycemia (blood glucose 33 mg/dL) and unresponsiveness require immediate treatment. Intramuscular glucagon is the priority since the IV line is infiltrated, and oral intake is not feasible. Inserting a new IV or administering D50 IV can follow once access is restored.