A nurse is teaching a client, who is newly diagnosed with type 1 diabetes mellitus, about insulin safety.
Which of the following statements by the nurse is appropriate?
Storing insulin in the freezer will prolong its stability.
Clients with type 1 diabetes mellitus should keep backup medication and supplies in their car.
All insulins can be mixed in the same syringe.
Insulin is stable at room temperature for one month.
The Correct Answer is D
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Promethazine is an antihistamine with potent antiemetic properties often used in the postoperative setting to manage nausea and vomiting. The intravenous route is appropriate for a patient who is actively vomiting and unable to tolerate oral intake. By blocking dopamine receptors in the chemoreceptor trigger zone, it effectively reduces the vomiting reflex. Since the patient is in the PACU and actively emetic, parenteral administration ensures rapid onset of action and reliable systemic absorption.
Choice B rationale
Ondansetron is a highly effective 5-HT3 receptor antagonist used for postoperative nausea. however, the oral route is contraindicated for a patient who is actively vomiting. If a patient cannot keep fluids down, a pill or disintegrating tablet will likely be expelled before it can be absorbed in the gastrointestinal tract. In the immediate postoperative phase with active emesis, the nurse must prioritize non-oral routes, such as intravenous or intramuscular, to achieve therapeutic effects.
Choice C rationale
Acetaminophen administered rectally is an analgesic and antipyretic medication. While it bypasses the oral route, it does nothing to address the patient's primary distress, which is active vomiting. The question asks for an appropriate medication for a patient who is vomiting, and Tylenol lacks antiemetic properties. Using a rectal suppository for pain might be a secondary consideration, but it does not treat the underlying gastric distress or the risk of aspiration and dehydration.
Choice D rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug used for pain and inflammation. Like other oral medications, it is inappropriate for a patient experiencing active emesis. Furthermore, NSAIDs can cause gastric irritation, which might worsen the patient's nausea. In the postoperative period, especially following a cholecystectomy, maintaining a patent airway and stopping vomiting is the priority. Giving an oral medication during active vomiting is ineffective and increases the risk of the patient choking or inhaling vomitus.
Correct Answer is C
Explanation
Choice A rationale
Hyperthermia represents a hypermetabolic state where the body temperature can rise rapidly, sometimes exceeding 44 degrees Celsius. Internal cooling measures are vital to prevent cellular damage and multi-organ failure. A cooling blanket facilitates conductive heat loss through the skin. Reducing the core temperature is a priority to stabilize the metabolic rate and prevent the denaturation of critical proteins and enzymes within the systemic circulation during a crisis.
Choice B rationale
Malignant hyperthermia causes a massive increase in oxygen consumption and carbon dioxide production due to sustained muscle contractions. Normal respiration rates of 12 to 20 breaths per minute are insufficient. Providing high-flow 100 percent oxygen helps meet the increased metabolic demands of the tissues and assists in the elimination of excess carbon dioxide. This intervention is necessary to prevent severe respiratory and metabolic acidosis during the intraoperative emergency.
Choice C rationale
Administering warmed intravenous fluids is contraindicated because the primary goal in malignant hyperthermia is to lower the body temperature rapidly. Warmed fluids would further elevate the core temperature, exacerbating the hypermetabolic state and worsening the clinical outcome. Instead, chilled or cold intravenous saline is typically administered to help cool the patient from the inside out. This choice represents an inappropriate action that could harm the patient.
Choice D rationale
Dantrolene sodium is the specific pharmacological treatment for malignant hyperthermia. It acts as a muscle relaxant by abolishing the excitation-contraction coupling in muscle cells. Specifically, it inhibits the release of calcium ions from the sarcoplasmic reticulum. By lowering intracellular calcium levels, it stops the uncontrolled muscle contractions and the resulting heat production. Prompt administration is the most effective way to reverse the life-threatening symptoms and stabilize the patient.
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