A nurse is providing discharge teaching to a client who has diabetes mellitus and a new prescription for regular and NPH insulin. Which of the following statements by the client indicates an understanding of the teaching?
"I will inject air into both vials before pulling up the insulins into the syringe."
"I will shake the insulin vials vigorously before drawing up the medication."
"I will draw up the NPH insulin first and then the regular insulin."
"I will insert the needle into my abdomen at a 15° angle."
The Correct Answer is A
Insulin therapy management involves the precise coordination of short-acting and intermediate-acting agents to mimic physiological glucose regulation. Regular insulin acts rapidly, whereas NPH insulin contains protamine to delay absorption and extend the duration of action. Proper mixing technique is vital to maintain the integrity of each medication and ensure accurate glycaemic control without causing cross-contamination.
Rationale:
A. Injecting air into both vials is the correct first step when mixing insulins to prevent the creation of a vacuum. The nurse must teach the client to inject air equal to the dose into the NPH vial first, followed by air into the regular vial. This equalization of pressure allows for the smooth withdrawal of the liquid medication without contaminating the regular insulin with NPH.
B. Shaking insulin vials vigorously is contraindicated as it creates air bubbles that interfere with accurate dose measurement and can denature the protein molecules. Instead, NPH insulin, which is a suspension, should be gently rolled between the palms to redistribute the particles. Regular insulin is a clear solution and does not require any agitation or rolling before withdrawal from the vial.
C. Drawing up NPH insulin first is an incorrect technique that risks contaminating the clear regular insulin vial with the cloudy protamine from the NPH. The standard protocol is to draw the "clear before cloudy" (regular before NPH) to ensure the fast-acting insulin remains pure. Contamination of the regular vial with NPH would inadvertently alter the onset and peak characteristics of the short-acting dose.
D. Inserting the needle at a 15° angle is incorrect for subcutaneous insulin administration and is more appropriate for intradermal injections. Insulin must be deposited into the fatty subcutaneous tissue, typically at a 45° to 90° angle depending on the patient's body mass and needle length. A 15° angle would likely result in an ineffective intradermal delivery, leading to unpredictable absorption rates.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Filgrastim is a granulocyte colony-stimulating factor(G-CSF) used to stimulate the production of neutrophilsand reduce the duration of neutropenia. It acts on hematopoietic cells to increase phagocytic activity, but its timing relative to cytotoxic chemotherapy is critical to prevent drug interaction.
Rationale:
A.A decreased neutrophil count is the primary indication for administering filgrastim, not a reason for an incident report. The medication is specifically intended to treat or prevent febrile neutropenia in clients undergoing myelosuppressive therapy. Finding a low absolute neutrophil count justifies the use of the growth factor to boost the client's immune defense.
B.Filgrastim vials are stable at room temperature for up to 24 hours depending on specific manufacturer guidelines. Leaving the vial out for only 2 hours does not compromise the integrity of the medication or constitute a medication error. Therefore, this action does not necessitate an incident report as the medication remains safe for administration to the client.
C.Filgrastim should not be administered within 24 hours before or after the administration of cytotoxic chemotherapy. Giving the medication only 12 hr after chemotherapy is a significant timing error that can interfere with the effectiveness of the treatment and worsen marrow suppression. The nurse must complete an incident report to document this violation of the safety protocol for colony-stimulating factors.
D.Nausea is a common side effect of chemotherapy and can also occur with filgrastim, though it is not a reason for an incident report. Incident reports are reserved for errors, accidents, or unexpected hazardous events, not for documenting known, documented adverse reactions. The nurse should manage the nausea with antiemetics rather than filing an administrative error report.
Correct Answer is C,A,D,B
Explanation
Stop the infusion.
Disconnect the IV tubing from the IV hub.
Aspirate the medication from the IV catheter.
Elevate the affected extremity.
Brief Introduction:
Extravasationis a severe clinical complication where a vesicantmedication leaks from the intravascular space into the surrounding dermal or subcutaneous tissue. Vesicants, such as certain chemotherapeutic agents, cause cellular necrosis, tissue sloughing, and permanent nerve damage upon contact with extravascular structures. Emergency management focuses on immediate cessation of the insult and the removal of as much residual toxin as possible to mitigate localized destruction.
Rationale:
A. Disconnecting the IV tubingfrom the IV hub is the second priority action. Once the pump is deactivated, the tubing must be removed while leaving the catheter in place to serve as a conduit for further intervention. This step prepares the site for aspirationand prevents any further residual medication within the line from being accidentally flushed into the compromised tissue.
B. Elevating the affected extremityis the final step in the immediate response sequence. Elevation utilizes gravity to promote venous returnand lymphatic drainage, which helps reduce localized edema and limits the spread of the vesicant within the interstitial spaces. This maneuver is part of supportive care and should only be performed after the chemical threat has been physically addressed.
C. Stop the infusionis the absolute first action the nurse must perform the moment extravasation is suspected. Continued administration of a vesicant exponentially increases the volume of tissue exposed to the toxin, leading to wider areas of necrosis. Halting the flow immediately limits the scope of the injury and is the highest priority for limb preservation and safety.
D. Aspirate the medicationfrom the client's IV catheter is performed after the tubing is disconnected but before the catheter is removed. Using a syringe to pull back on the hub allows the nurse to extract residual vesicant still sitting in the catheter and the immediate extravasation pocket. This critical step reduces the total concentration of the drug remaining in the tissue, potentially decreasing the severity of the subsequent chemical burn.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.