A 55-year-old patient with type 2 diabetes is admitted to the hospital and is on NPH insulin. The patient experiences symptoms of hypoglycemia. At what time after administration of NPH insulin should the nurse be most vigilant for signs of hypoglycemia due to the peak action of the insulin?
18-24 hours after administration
4-12 hours after administration
12-18 hours after administration
1-2 hours after administration
The Correct Answer is B
Choice A Reason:
NPH insulin is an intermediate-acting insulin that typically has a duration of action of about 12 to 16 hours. The peak action, however, occurs much earlier, making 18-24 hours after administration an incorrect choice for the peak time of hypoglycemia risk.
Choice B Reason:
NPH insulin generally peaks 4 to 12 hours after administration This is the period when the insulin is most effective at lowering blood glucose levels, and therefore, the time when the patient is at the highest risk for hypoglycemia. Monitoring for signs of hypoglycemia during this window is crucial to ensure patient safety.
Choice C Reason:
While NPH insulin can have effects lasting up to 16 hours, the peak action occurs earlier, between 4 to 12 hours. Therefore, 12-18 hours after administration is not the correct time frame for the peak action of NPH insulin.
Choice D Reason:
NPH insulin starts to act within 1 to 2 hours after administration, but this is not the peak time. The peak action, when the risk of hypoglycemia is highest, occurs later, between 4 to 12 hours after administration.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","F"]
Explanation
Choice A Reason:
Acetone breath is typically associated with diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). DKA occurs when there is a significant production of ketones due to the breakdown of fat for energy, leading to a fruity or acetone-like smell on the breath. HHS, on the other hand, does not usually involve significant ketone production.
Choice B Reason:
Fever can be a manifestation of HHS, especially if there is an underlying infection or illness that has precipitated the hyperglycemic crisis. Infections are common triggers for HHS and can contribute to the severity of the condition.
Choice C Reason:
Older age is a risk factor for HHS. HHS is more commonly seen in older adults with type 2 diabetes, often those who have underlying chronic conditions or are experiencing acute illness. The patient’s age of 68 years supports the likelihood of HHS.
Choice D Reason:
A serum glucose level of 800 mg/dL is indicative of HHS. HHS is characterized by extremely high blood glucose levels, often exceeding 600 mg/dL, without significant ketone production. This high glucose level leads to severe dehydration and hyperosmolarity.
Choice E Reason:
A serum bicarbonate level of 15 mEq/L is more indicative of DKA rather than HHS. In HHS, serum bicarbonate levels are typically normal or only mildly decreased because there is no significant ketoacidosis. Therefore, this choice does not support the clinical presentation of HHS.
Choice F Reason:
An insidious onset is characteristic of HHS. Unlike DKA, which can develop rapidly, HHS often develops over days to weeks. Patients may experience gradually worsening symptoms such as increased thirst, frequent urination, and confusion before seeking medical attention.
Correct Answer is B
Explanation
Choice A: Instruct the patient to elevate the arm above the heart immediately after the procedure
Elevating the arm above the heart can help reduce blood flow to the area, potentially minimizing bleeding. However, this method alone is not sufficient to ensure proper hemostasis, especially in patients with thrombocytopenia. Applying direct pressure to the puncture site is more effective in stopping bleeding and preventing hematoma formation.
Choice B: Apply firm pressure to the site for at least 10 minutes after the procedure
Applying firm pressure to the venipuncture site is crucial in patients with thrombocytopenia to ensure proper clotting and prevent bleeding. This method helps in forming a stable clot at the puncture site, reducing the risk of prolonged bleeding and hematoma formation. Given the patient’s low platelet count, maintaining pressure for an extended period is essential to achieve hemostasis.
Choice C: Avoid using a tourniquet during the procedure
While avoiding a tourniquet might seem beneficial to reduce pressure on the veins, it is not a standard practice to minimize bleeding risk in thrombocytopenic patients. Tourniquets are typically used to make veins more prominent for easier access during venipuncture. The key to minimizing bleeding is proper post-procedure care, such as applying firm pressure to the site.
Choice D: Use a larger gauge needle to ensure quicker blood flow
Using a larger gauge needle is not advisable for patients with thrombocytopenia. Larger needles can cause more trauma to the vein, increasing the risk of bleeding and hematoma formation. Instead, using the smallest gauge needle that can effectively draw blood is recommended to minimize vein damage.
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