A nurse has administered antianxiety preoperative medications to a client.
Which of the following actions should the nurse implement?

Choice A rationale

Hypoglycemia is generally a complication of diabetes treatment, such as excessive insulin administration or inadequate carbohydrate intake, rather than a direct result of the disease process itself. In type 1 diabetes, the primary physiological issue is the autoimmune destruction of beta cells, leading to a total lack of endogenous insulin. Without external insulin, blood glucose levels will rise, not fall. Therefore, the nurse monitors for hypoglycemia primarily as a side effect of the exogenous insulin therapy provided.

Choice B rationale

Neuroglycopenia refers to a shortage of glucose in the brain, which usually occurs when blood glucose levels fall below 50 mg/dL. While this is a serious concern for patients with type 1 diabetes who are receiving insulin, it is not the direct result of a lack of insulin production. In fact, a lack of insulin results in hyperglycemia, where there is plenty of glucose in the blood but it cannot enter the cells. Neuroglycopenia is a symptom of the treatment, not the underlying deficiency.

Choice C rationale

Insulin is the primary hormone responsible for glycogenesis, which is the conversion of glucose into glycogen for storage in the liver and muscles. In a client with type 1 diabetes, the absolute lack of insulin prevents the body from storing glucose effectively. Instead of increased storage, the body undergoes glycogenolysis and gluconeogenesis to further increase blood sugar levels. Thus, the nurse would expect to see depleted glycogen stores rather than an increase in storage due to the insulin deficit.

Choice D rationale

Diabetic ketoacidosis is a life threatening complication directly caused by an absolute lack of insulin in type 1 diabetes. Without insulin, the body cannot use glucose for energy and begins breaking down fats. This process produces acidic ketones, leading to metabolic acidosis. Clinical signs include Kussmaul respirations and a fruity breath odor. Laboratory findings typically show a blood glucose greater than 250 mg/dL, a serum bicarbonate less than 18 mEq/L, and a pH less than 7.30.

Choice A rationale

Freezing insulin is dangerous because it causes the proteins to denature and lose their physiological activity. When insulin molecules are subjected to temperatures below 0 degrees Celsius, the structural integrity of the hormone is permanently compromised. This results in unpredictable glycemic control and potential crystallization. Patients must be taught that once insulin has been frozen, it must be discarded immediately, even if it has thawed, because its potency is gone.

Choice B rationale

Storing backup medical supplies in a vehicle is inappropriate due to extreme temperature fluctuations that occur within a car. Insulin is a sensitive protein that degrades when exposed to excessive heat or cold. High temperatures can cause the insulin to clump or lose its effectiveness, leading to hyperglycemia. Medical supplies like glucose monitors and test strips are also sensitive to environmental stressors, which can lead to inaccurate readings and unsafe clinical decisions.

Choice C rationale

Not all insulin types are compatible for mixing within a single syringe. While intermediate-acting NPH can often be mixed with rapid-acting or short-acting insulins, long-acting basal insulins like glargine or detemir must never be mixed. These long-acting analogs have a specific pH that maintains their slow-release properties. Mixing them with other insulins alters their pH and changes their absorption rate, which significantly increases the risk of unpredictable hypoglycemia or poor glucose management.

Choice D rationale

Most insulin vials and pens currently in use remain stable and potent at room temperature, typically between 15 and 30 degrees Celsius, for approximately 28 to 30 days. This practice helps reduce local tissue irritation and injection site discomfort that often occurs when injecting cold insulin. After one month at room temperature, the preservative and the insulin protein itself begin to degrade, necessitating the disposal of any remaining medication to ensure patient safety.