A patient has been admitted with a diagnosis of “hypertensive emergency”, with a blood pressure of 198/110 mmHg and a heart rate of 78 bpm.
Which medications would the nurse anticipate being prescribed to the patient in the ICU setting to lower the patient’s blood pressure? (Select all that apply)

Choice A rationale:

Requesting an order for morphine sulfate IV 2 mg over 1-5 minutes would not be appropriate at this time for several reasons: The patient has already received a dose of 4 mg 15 minutes ago, and it has not been effective in relieving the chest pain.

The patient is showing signs of increased respiratory effort, which could be a sign of respiratory depression. Administering an additional dose of morphine could worsen the respiratory depression.

The patient's heart rate is 82 beats per minute, which is within the normal range.

The patient's blood pressure is 135/88 mm Hg, which is also within the normal range.

Choice C rationale:

Administering naloxone (Narcan) to counteract respiratory depression would not be appropriate at this time because the patient is not showing signs of severe respiratory depression. Naloxone is a medication that is used to reverse the effects of opioid overdose. It is typically only used in situations where the patient is experiencing life-threatening respiratory depression.

Choice D rationale:

Administering morphine sulfate IV 4 mg over 1-5 minutes would not be appropriate for the reasons listed above. It could worsen the patient's respiratory depression and potentially lead to other complications.

Choice B is the best answer because it is the most conservative and safest option. By withholding the next dose of morphine and informing the provider about the patient's symptoms, the nurse can ensure that the patient receives the appropriate care and that any potential complications are avoided.

Choice A rationale:

Insulin glargine (Lantus) is a long-acting insulin analog that is designed to provide a steady, basal level of insulin throughout the day.

It has a duration of action of approximately 24 hours, so it is typically administered once daily at bedtime.

This helps to control blood glucose levels overnight and during the early morning hours, when the risk of hypoglycemia is highest.

Key characteristics of Insulin Glargine (Lantus):

Onset: 1-2 hours

Peak: No pronounced peak Duration: Approximately 24 hours

Administration: Once daily at bedtime

Choice B rationale:

Lispro (Humalog) is a rapid-acting insulin analog that is designed to be taken with meals to help control blood glucose spikes after eating.

It has a onset of action of approximately 15 minutes and a duration of action of 2-4 hours.

Because of its rapid onset and short duration of action, lispro is not typically used as a basal insulin. Key characteristics of Lispro (Humalog):

Onset: 15 minutes

Peak: 30-90 minutes

Duration: 2-4 hours

Administration: With meals

Choice C rationale:

Insulin detemir (Levemir) is another long-acting insulin analog that is similar to insulin glargine in terms of its duration of action.

It is typically administered once daily at bedtime to provide basal insulin coverage. Key characteristics of Insulin Detemir (Levemir):

Onset: 1-2 hours

Peak: No pronounced peak

Duration: Approximately 18-24 hours Administration: Once daily at bedtime Question 23.

The nurse receives an order for insulin: NPH (Humulin NPH) 10 units to be administered intravenously daily at 7:00am.

What action should the nurse take?

A. Administer the dose but ensure that if mixed with another Humulin-R insulin, to draw the regular insulin up first.

B. Give the drug subcutaneously rather than IV

C. Review the insulin order with the prescriber and pharmacy.

D. Administer the insulin ordered mixed in 50 ML of 0.9%NS IV Piggyback (not to infuse faster than 1/2 hour or 30 minutes).

The correct answer is C. Review the insulin order with the prescriber and pharmacy.

Rationale for Choice A:

Intravenous administration of NPH insulin is not recommended. It is an intermediate-acting insulin that is designed to be absorbed slowly from the subcutaneous tissue. IV administration can lead to rapid and unpredictable changes in blood glucose levels, which can be dangerous.

Mixing NPH insulin with regular insulin does not change the route of administration. Both insulins should still be given subcutaneously.

Rationale for Choice B:

Subcutaneous administration of NPH insulin is the correct route. This allows for slow and steady absorption of the insulin, which helps to prevent blood glucose fluctuations.

However, the nurse should still clarify the order with the prescriber and pharmacy. This is because IV insulin orders are unusual and may be a mistake.

Rationale for Choice D:

Adding NPH insulin to a 50 mL IV piggyback is not a safe practice. This would dilute the insulin and make it even more difficult to control the rate of infusion.

IV insulin infusions are typically administered using a dedicated insulin pump. This allows for precise control of the infusion rate and helps to prevent hypoglycemia.

Rationale for Choice C:

Reviewing the insulin order with the prescriber and pharmacy is the safest course of action. This will help to ensure that the order is correct and that the insulin is administered safely.

The prescriber may have meant to order regular insulin instead of NPH insulin. Regular insulin can be given intravenously, but it requires careful monitoring of blood glucose levels.

The pharmacy can also double-check the order and ensure that the correct insulin is dispensed.