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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While some beta-blockers have a minor effect on vasodilation, their primary purpose in a post-MI patient is not to dilate the coronary arteries. Beta-blockers reduce myocardial oxygen demand by decreasing heart rate, contractility, and blood pressure. Vasodilators, such as nitrates or calcium channel blockers, are the drugs of choice for dilating coronary arteries.
Choice B rationale
After an MI, circulating catecholamines (epinephrine and norepinephrine) can increase heart rate and contractility, which raises myocardial oxygen demand and can extend the size of the infarct. Metoprolol, a beta-blocker, competitively blocks these catecholamines at the beta-1 adrenergic receptors, thereby reducing heart rate and myocardial contractility. This action decreases oxygen consumption and prevents further cardiac damage.
Choice C rationale
Beta-blockers like metoprolol have a negative inotropic effect, meaning they decrease the force of myocardial contraction. A positive inotropic effect, which increases the force of contraction, is seen with drugs like digoxin or dopamine and would be counterproductive in a post-MI setting where the goal is to reduce the heart's workload.
Choice D rationale
While metoprolol does lower blood pressure as a secondary effect by decreasing heart rate and reducing cardiac output, its primary purpose in a post-MI patient is to reduce the workload of the heart and decrease myocardial oxygen demand. The reduction in blood pressure is a beneficial side effect, but it is not the main indication for its use in this context.
Correct Answer is C
Explanation
Choice A rationale
Beta-blockers, or beta-adrenergic antagonists, primarily work by blocking the effects of epinephrine (adrenaline) and norepinephrine on beta receptors. This action leads to a decrease in heart rate, a reduction in the force of myocardial contraction, and a decrease in the conduction velocity through the atrioventricular (AV) node, thereby reducing cardiac output and blood pressure. They do not directly cause peripheral vasodilation.
Choice B rationale
Diuretics reduce blood pressure by increasing the excretion of sodium and water from the body. This action decreases intravascular fluid volume, leading to a reduction in cardiac output and systemic blood pressure. While this does reduce blood pressure, their primary mechanism is not the direct reduction of peripheral vascular resistance; it's volume depletion.
Choice C rationale
Vasodilators act directly on the smooth muscle of the blood vessels, causing them to relax and widen (vasodilation). This widening increases the radius of the blood vessels, which in turn decreases the resistance to blood flow through the peripheral circulation, thus lowering blood pressure. This direct action on vascular smooth muscle makes them highly effective at reducing peripheral vascular resistance.
Choice D rationale
Alpha-adrenergic blockers, or alpha-antagonists, block the effects of norepinephrine on alpha-1 receptors in the smooth muscle of arterioles and venules. This blockage prevents vasoconstriction and leads to vasodilation, thereby reducing peripheral vascular resistance and lowering blood pressure. However, they are not the most effective class overall, and vasodilators have a broader mechanism.
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