A newly diagnosed client with type I diabetes was admitted to the ICU with the diagnosis of diabetic ketoacidosis.
After being transferred to the med/surg unit, he asks if he can receive today’s NPH and regular insulin the same way to avoid being “stuck” since there is still an IV access.
Which information should be included in the nurse’s response?
Only regular insulin may be given IV and you will now receive your insulins subcutaneously as ordered
Mixing these two insulins may increase their potency and increase the risk of hypoglycemia
These two insulins are not compatible and cannot be mixed together
NPH Insulin can only be given IV in the ICU environment as an insulin drip
The Correct Answer is A
Rationale for A:
Regular insulin is the only insulin formulation that can be safely administered intravenously. It is a rapid-acting insulin that starts working within 15 minutes and peaks in 1-2 hours, making it ideal for urgent glucose control in situations like diabetic ketoacidosis.
NPH insulin is an intermediate-acting insulin that is not suitable for IV administration. It is designed to be absorbed slowly over several hours, and injecting it intravenously could lead to unpredictable and potentially dangerous fluctuations in blood glucose levels.
Subcutaneous (SQ) injection is the standard route of administration for both regular and NPH insulin outside of acute care settings. This route allows for a more gradual and consistent absorption of insulin, which is essential for maintaining stable blood glucose control.
The patient's transfer to the med/surg unit indicates that their condition has stabilized and no longer requires the aggressive glucose control that is achieved with an IV insulin infusion. Therefore, it is appropriate to transition them to SQ insulin injections.
Rationale for B:
While mixing insulins can potentially alter their absorption rates and action profiles, the primary concern with mixing NPH and regular insulin is not an increased risk of hypoglycemia. It is the incompatibility of the formulations for IV administration.
Rationale for C:
NPH and regular insulin can be mixed together for subcutaneous injection, but they are not compatible for intravenous administration.
Rationale for D:
While NPH insulin can be administered as part of an IV insulin drip in the ICU, this is typically done in specific situations where a continuous infusion of both rapid-acting and intermediate-acting insulin is required. It is not the standard practice for NPH insulin administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Digoxin is a cardiac glycoside, not a calcium channel blocker. It works by increasing the force of contraction of the heart muscle and slowing the heart rate. However, it is not typically used as a first-line treatment for tachycardia. It's more commonly used to treat heart failure and atrial fibrillation.
Mechanism of action: Digoxin inhibits the sodium-potassium ATPase pump in cardiac cells, leading to an increase in intracellular calcium. This increased calcium availability enhances myocardial contractility. Digoxin also indirectly affects the autonomic nervous system, leading to a decrease in heart rate.
Key points:
Digoxin is not a calcium channel blocker.
It's used primarily for heart failure and atrial fibrillation.
Its mechanism of action involves increasing intracellular calcium and decreasing heart rate.
Choice B rationale:
Diltiazem (Cardizem) is a calcium channel blocker that is commonly used to treat tachycardia and manage heart rate. It works by blocking the movement of calcium into cardiac cells, which slows down the electrical conduction system of the heart and leads to a decrease in heart rate.
Mechanism of action: Diltiazem blocks L-type calcium channels in cardiac and vascular smooth muscle cells. This reduces calcium influx, leading to:
Decreased myocardial contractility Vasodilation (relaxation of blood vessels)
Negative chronotropic effect (decreased heart rate)
Negative dromotropic effect (slowed conduction through the AV node) Key points:
Diltiazem is a calcium channel blocker.
It's effective in treating tachycardia and managing heart rate.
Its mechanism of action involves blocking calcium channels, leading to various cardiovascular effects.
Choice C rationale:
Nitroglycerin is a vasodilator, not a calcium channel blocker. It works by relaxing the smooth muscle in blood vessels, which widens the vessels and allows more blood to flow through them. This can help to relieve chest pain (angina) and lower blood pressure, but it does not directly affect heart rate.
Mechanism of action: Nitroglycerin is metabolized to nitric oxide, which activates guanylate cyclase, leading to increased production of cyclic guanosine monophosphate (cGMP). cGMP causes smooth muscle relaxation, resulting in vasodilation.
Key points:
Nitroglycerin is a vasodilator, not a calcium channel blocker. It's primarily used for angina and hypertension.
Its mechanism of action involves nitric oxide-mediated vasodilation.
Choice D rationale:
Nitroprusside (Nipride) is a potent vasodilator, not a calcium channel blocker. It is typically used in critical care settings to manage severe hypertension or heart failure. It works by relaxing the smooth muscle in blood vessels, which widens the vessels and allows more blood to flow through them. This can help to lower blood pressure, but it does not directly affect heart rate.
Mechanism of action: Nitroprusside directly releases nitric oxide, leading to vasodilation. Key points:
Nitroprusside is a potent vasodilator, not a calcium channel blocker.
It's used in critical care settings for severe hypertension or heart failure.
Its mechanism of action involves direct nitric oxide release and vasodilation.
Correct Answer is C
Explanation
Choice A rationale:
Fever is not a common side effect of metformin. While it's possible for a minority of patients to experience a mild fever as their bodies adjust to the medication, it's not considered a typical or expected adverse effect.
Fevers typically occur due to infections or inflammation, and metformin does not directly cause either of these processes.
If a patient taking metformin develops a fever, it's crucial to rule out other potential causes, such as infections or other medications, before attributing it to metformin.
Choice B rationale:
Insomnia is also not a common side effect of metformin. In fact, some studies have suggested that metformin may even have a positive effect on sleep quality in some individuals.
While sleep disturbances can occur with any medication, they are not specifically associated with metformin.
If a patient experiences insomnia while taking metformin, it's essential to consider other potential factors, such as stress, anxiety, or other medications, that could be contributing to sleep problems.
Choice C rationale:
Bitter or metallic taste is a very common side effect of metformin, experienced by approximately 30-40% of patients. This taste disturbance is thought to be caused by metformin's interaction with taste receptors on the tongue.
The taste is often described as metallic, bitter, or similar to the taste of pennies.
While it can be unpleasant, it's generally not considered a serious side effect and does not usually require discontinuation of the medication.
Some strategies to manage the metallic taste include: Taking metformin with meals or snacks to mask the taste.
Chewing sugar-free gum or sucking on hard candy after taking the medication. Rinsing the mouth with water or mouthwash after taking the medication.
Switching to an extended-release formulation of metformin, which may have a less pronounced metallic taste.
Choice D rationale:
Seizures are a rare but serious side effect of metformin.
They are most likely to occur in patients with underlying kidney problems or those taking certain other medications that can interact with metformin.
If a patient taking metformin experiences a seizure, it's critical to seek immediate medical attention.
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