A patient is being discharged home with insulin lispro and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient?

Draw up the insulin lispro first and then draw up the NPH into the same syringe.

Store the insulins in the refrigerator.

Shake the insulins for 1 full minute before use.

Administer the injection at a 30-degree angle to your skin.

Answer and Explanation

The Correct Answer is A

Choice A rationale

When mixing insulin lispro (rapid-acting) with NPH (intermediate-acting), it is a standard and crucial procedure to draw the clear rapid-acting insulin first, followed by the cloudy NPH insulin. This is to prevent the contamination of the rapid-acting vial with the NPH suspension, which could alter the rapid-acting insulin's predictable onset and peak.

Choice B rationale

While unopened insulin vials should be stored in the refrigerator, the patient's current in-use vials can be stored at room temperature for up to 28 days to make injections more comfortable. Injecting cold insulin can cause discomfort and lipohypertrophy at the injection site. However, the refrigerator is where all unopened vials are stored.

Choice C rationale

Shaking the insulin for a full minute is not recommended. Vigorous shaking can cause foaming and bubble formation, which can lead to inaccurate dosing. NPH insulin, a suspension, should be gently rolled between the palms to ensure uniform mixing and proper suspension of the particles, which prevents clumping and allows for accurate dosing.

Choice D rationale

Administering an injection at a 30-degree angle is not standard practice for subcutaneous insulin injections. Insulin is injected into the subcutaneous fat layer. A 90-degree angle is commonly used for most patients, and a 45-degree angle may be used for very thin individuals or for injections into the arms. A 30-degree angle is not correct.

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Correct Answer is B

Explanation

Choice A rationale

Digoxin is a cardiac glycoside that increases myocardial contractility and stroke volume, leading to improved cardiac output. It primarily affects the heart's pumping ability and heart rate, but it is not the main drug used to reduce both preload and afterload. Its role is more to manage symptoms of heart failure and improve cardiac output.

Choice B rationale

ACE inhibitors (e.g., lisinopril) work by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to vasodilation, which decreases both systemic vascular resistance (afterload) and venous pressure (preload), making them a cornerstone for treating heart failure and reducing the workload on the heart.

Choice C rationale

Beta-blockers (e.g., carvedilol) block the effects of epinephrine and norepinephrine on beta receptors, leading to a decrease in heart rate and contractility. This reduces myocardial oxygen demand and can improve ventricular remodeling over time in heart failure, but they do not primarily reduce both preload and afterload in the same way as ACE inhibitors.

Choice D rationale

Diuretics (e.g., furosemide) work by increasing the excretion of sodium and water from the body, which reduces blood volume. This primarily reduces preload (volume returned to the heart) and is used to manage symptoms like edema and congestion, but it is not as effective at reducing afterload as ACE inhibitors.

A. Insomnia. B. Yellow skin. C. Bruising. D. Increased appetite.

Correct Answer is C

Explanation

Choice A rationale

Valerian is a sedative herb used to treat insomnia and anxiety. It promotes sleep and has a calming effect on the central nervous system. Therefore, insomnia is the opposite of its intended therapeutic effect and would not be considered an adverse effect.

Choice B rationale

Valerian is not typically associated with causing jaundice or yellow skin. Yellow skin is a symptom of liver dysfunction, which is more commonly associated with certain other herbal supplements. While rare, liver injury is possible with valerian.

Choice C rationale

Valerian may affect blood clotting and can increase the risk of bleeding. This can manifest as bruising or an increased propensity for bleeding. Patients taking anticoagulants or antiplatelet drugs should be cautioned about this potential interaction.

Choice D rationale

Valerian is used as a sleep aid and sedative. It does not typically increase appetite. Increased appetite is more often associated with certain psychotropic medications or medical conditions, and it is not a known adverse effect of valerian.

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A patient is being discharged home with insulin lispro and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient?

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Naxlex Comprehensive Predictor Exams

Which medication is commonly used to reduce preload and afterload in heart failure?

Correct Answer is B

Explanation

The patient tells the nurse that his friend has been taking valerian for a long period of time and that he isn't feeling so well. The patient asks the nurse what the adverse effects of valerian are. What adverse effect with valerian would the nurse discuss with the patient?

Correct Answer is C

Explanation

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