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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.
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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 at a health care facility is assigned to administer insulin to the client. Which of the following interventions should the nurse perform before administering each insulin dose?
- A. Inspect the previous injection site for inflammation.
- B. Keep prefilled syringes horizontally.
- C. Check for symptoms of myalgia or malaise.
- D. Mix the insulin with sterile water in the syringe.
Correct Answer: A
Rationale: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should not be mixed with other drugs in the syringe. Some types of insulin may be combined in one syringe, but sterile water is never used.
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.
After administering insulin detemir to a client with diabetes, the nurse suspects that the client is developing hypoglycemia based on assessment of which of the following?
- A. Increased thirst
- B. Increased urination
- C. Headache
- D. Confusion
- E. Diaphoresis
Correct Answer: C,D,E
Rationale: The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsions, dizziness, unconsciousness, hunger, nausea, diaphoresis, and numbness or tingling of the lips or tongue. Increased thirst and urination suggest hyperglycemia.
The nurse is assessing a client for risk factors associated with type 2 diabetes. Which of the following would the nurse identify?
- A. Younger age
- B. Impaired glucose tolerance
- C. Caucasian race
- D. Obesity
- E. History of gestational diabetes
Correct Answer: B,D,E
Rationale: A nurse should be able to identify all the risk factors for type 2 diabetes in a client. These include obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (African Americans, Hispanic Latino Americans, Native Americans, and some Asian Americans).