A nurse has just administered the morning dose of a patient's lispro (Humalog) insulin.
Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late.
What will the nurse do next?
Inform the patient of the delay.
Check the patient's blood glucose levels.
Give the patient food, such as cereal and skim milk, and juice.
Call the dietary department to send a tray immediately.
The Correct Answer is C
Choice A rationale
Simply informing the patient of the delay does not address the immediate physiological need. Lispro (Humalog) is a rapid-acting insulin with an onset of action of 15 to 30 minutes, a peak of 0.5 to 2.5 hours, and a duration of 3 to 6 hours. Waiting 45 minutes for the tray puts the patient at significant risk for hypoglycemia.
Choice B rationale
While checking the blood glucose level is good practice, it is not the most urgent action. The priority is to prevent hypoglycemia, which is an immediate and potentially life-threatening complication of giving rapid-acting insulin without a meal. The patient is already at risk given the time elapsed.
Choice C rationale
Lispro (Humalog) has a rapid onset of action, so the patient must eat within 15 to 30 minutes of administration to prevent hypoglycemia. Providing a fast-acting carbohydrate source like juice, followed by a protein and complex carbohydrate source like cereal and skim milk, will raise blood glucose levels and prevent a hypoglycemic event until the breakfast tray arrives.
Choice D rationale
While calling dietary to expedite the tray is a reasonable action, it may not be fast enough to prevent a hypoglycemic event. The most immediate and critical action is to provide the patient with food to counteract the rapid action of the lispro insulin. This directly addresses the patient's safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Clonidine is a centrally acting alpha-2 adrenergic agonist. While it is an effective antihypertensive, it has been associated with adverse effects on the liver, including hepatitis and elevated liver enzymes. For a patient with a history of cirrhosis, which involves irreversible liver damage and impaired function, a drug with potential hepatotoxicity is a poor choice as it could worsen the underlying liver disease.
Choice B rationale
Prazosin is an alpha-1 adrenergic blocker. It is a suitable choice for this patient. Unlike other antihypertensives, it does not typically cause adverse effects on the liver or pancreas. Its mechanism of action, causing vasodilation by blocking alpha-1 receptors, is not known to exacerbate either pancreatitis or cirrhosis. Therefore, it is a safe and effective option given the patient's co-morbidities.
Choice C rationale
Diltiazem is a calcium channel blocker. While generally safe, some calcium channel blockers have been associated with potential exacerbation of pancreatic inflammation. Although diltiazem is not the most common culprit, its use should be approached with caution in a patient with a history of pancreatitis due to the potential for pancreatic adverse effects. This makes it a less ideal choice compared to a drug with no known pancreatic side effects.
Choice D rationale
Captopril is an ACE inhibitor. This class of drugs has been associated with a potential risk of hepatotoxicity, including cholestatic jaundice and liver failure, although these are rare. In a patient with pre-existing cirrhosis, the liver's ability to metabolize drugs is already compromised, which increases the risk of drug accumulation and potential toxicity. Therefore, it would be a less favorable choice due to the risk of worsening liver function.
Correct Answer is A
Explanation
Choice A rationale
Beta-blockers reduce the workload on the heart by blocking the effects of catecholamines (epinephrine and norepinephrine) on beta-adrenergic receptors. This action leads to a decrease in heart rate, a reduction in the force of myocardial contraction (contractility), and a decrease in blood pressure. These effects collectively lower the heart's oxygen demand, which is crucial in preventing further damage after a myocardial infarction.
Choice B rationale
Beta-blockers do the opposite of this. They reduce heart rate and contractility by inhibiting the sympathetic nervous system's effect on the heart. This action is beneficial because it reduces the heart's workload and oxygen demand, helping to prevent further ischemic damage. Increasing heart rate and contractility would be detrimental to a post-MI patient as it would increase myocardial oxygen demand.
Choice C rationale
While beta-blockers do not directly cause coronary artery vasodilation, they improve overall coronary blood flow by reducing heart rate and increasing diastolic time. This allows more time for blood to flow through the coronary arteries to the myocardium. Calcium channel blockers or nitrates are the medications primarily used for direct vasodilation of the coronary arteries.
Choice D rationale
Beta-blockers do not prevent the formation of blood clots. This is the primary function of antiplatelet agents (like aspirin or clopidogrel) and anticoagulants (like heparin or warfarin). These medications work by inhibiting different parts of the coagulation cascade or platelet aggregation to prevent thrombosis in the coronary arteries.
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