A patient is scheduled to receive insulin aspart and insulin detemir.
What is the correct procedure for the nurse to draw up the insulins for administration?

Mix the detemir and aspart in the same syringe, drawing up the aspart first

Mix the detemir and aspart in the same syringe, drawing up the detemir first

Administer the two insulins using different syringes and different sites of the body

Roll the bottles between the palms of the hands before drawing up the insulins

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Incorrect. Mixing insulin detemir and insulin aspart in the same syringe is generally not recommended due to the following reasons:

Altered Pharmacokinetics: Mixing insulins can potentially alter their absorption and action profiles, leading to unpredictable blood glucose control.

Stability Concerns: The compatibility of different insulins in a mixed solution is not always guaranteed, potentially leading to precipitation or decreased potency.

Dosing Accuracy: Drawing up mixed insulins accurately can be challenging, especially when different dosages are required for each type.

Manufacturer Recommendations: Insulin manufacturers typically advise against mixing different insulins unless specifically instructed by a healthcare professional.

Choice B rationale:

Incorrect. While the order of drawing up insulins may have a minor impact on mixing, it does not address the fundamental concerns of mixing different insulins in the same syringe. The primary issue is the potential for altered pharmacokinetics, stability concerns, and dosing accuracy, as explained in the rationale for Choice A.

Choice D rationale:

Incorrect. Rolling insulin bottles between the palms is a technique used to gently resuspend insulin particles that may have settled at the bottom. However, it does not pertain to the correct procedure for drawing up different insulins for administration.

Choice C rationale:

Correct. Administering insulin detemir and insulin aspart using separate syringes and different injection sites is the most appropriate approach for several reasons:

Maintains Pharmacokinetics: It ensures that each insulin maintains its intended absorption and action profile, promoting optimal blood glucose control.

Ensures Stability: Using separate syringes eliminates the risk of potential incompatibility issues that could arise from mixing insulins.

Promotes Dosing Accuracy: Drawing up insulins in separate syringes allows for greater precision in administering the correct dosage of each type.

Aligns with Manufacturer Guidelines: This approach adheres to the recommendations of insulin manufacturers, ensuring safe and effective administration.

Additional Considerations:

Nurses should always consult the latest insulin administration guidelines and individual patient needs for optimal care.

Proper education and counseling should be provided to patients who require multiple insulin injections to ensure adherence and understanding of correct administration techniques.

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Correct Answer is A

Explanation

Choice A rationale:

Shearing force is the primary factor that contributes to the formation of pressure injuries when a patient's body slides downward. It occurs when two surfaces move in opposite directions, causing stress and strain on the tissues between them.

Compression of Tissues: When the patient's body slides downward, the skin and underlying tissues are compressed between the bony prominences (such as the sacrum or heels) and the surface of the bed. This compression restricts blood flow to the area, depriving the tissues of oxygen and nutrients.

Tissue Stretching and Tearing: As the body slides, the skin and underlying tissues are also stretched and pulled in opposite directions. This shearing force disrupts the normal alignment of cells and tissues, leading to microscopic tears and damage.

Impaired Blood Flow: Shearing force further compromises blood flow by stretching and compressing blood vessels. This reduces the delivery of oxygen and nutrients to the tissues, while also hindering the removal of waste products.

Tissue Damage and Necrosis: The combination of compression, stretching, and impaired blood flow leads to cell death and tissue necrosis. This is the hallmark of pressure injuries, which can range from superficial blisters to deep ulcers that extend into muscle and bone.

Factors that Increase Shearing Force: Certain factors can increase the risk of shearing force and pressure injury development, including:

Increased moisture (from sweat or incontinence) Decreased mobility

Poor skin integrity

Malnutrition

Friction from bedsheets

In conclusion, shearing force is the main factor that contributes to pressure injury formation when a patient's body slides downward. It disrupts blood flow, damages tissues, and can lead to significant wounds.

A. The patient will require a stable dose of the medication until the drug is discontinued. B. Tolerance occurs when the liver or kidneys are no longer able to metabolize the drug. C. The patient will continually require higher doses of the drug for the same effect to be achieved. D. Tolerance only develops when the patients do not take the medication as it is prescribed.

Correct Answer is C

Explanation

Choice A rationale:

Incorrect. Patients who develop tolerance to a medication do not typically maintain a stable dose over time. Instead, they often require increasing doses to achieve the same effect.

Physiological adaptation: The body adapts to the presence of the medication, leading to a decreased response over time. This adaptation can occur at various levels, including receptor downregulation, changes in enzyme activity, or alterations in neurotransmitter release.

Individual variability: The rate and extent of tolerance development vary significantly among individuals, influenced by factors such as genetics, age, overall health, and medication type.

Choice B rationale:

Incorrect. Impaired liver or kidney function can affect drug metabolism and elimination, but this is not the primary mechanism of tolerance.

Metabolic impairment: Liver or kidney dysfunction can lead to drug accumulation in the body, potentially increasing the risk of side effects or toxicity. However, this does not necessarily cause tolerance, which is a specific phenomenon of decreased responsiveness to the medication's effects.

Choice C rationale:

Correct. This statement accurately describes the hallmark characteristic of tolerance.

Dose escalation: As tolerance develops, patients often require higher doses of the medication to achieve the same therapeutic effect. This can lead to a cycle of increasing doses and potential risks of adverse effects.

Clinical implications: Tolerance is a significant consideration in medication management, as it can affect treatment efficacy, adherence, and the risk of side effects.

Choice D rationale:

Incorrect. Tolerance can develop even when patients adhere strictly to their prescribed medication regimen. It is a physiological phenomenon that is not solely dependent on patient behavior.

Adherence vs. tolerance: While non-adherence can contribute to treatment failure, it is not the underlying cause of tolerance.

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A patient is scheduled to receive insulin aspart and insulin detemir.What is the correct procedure for the nurse to draw up the insulins for administration?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which factor contributes to the formation of a pressure injury when a patient’s body slides downward to the foot of the bed?

Correct Answer is A

Explanation

Which statement accurately describes patient tolerance to medications?

Correct Answer is C

Explanation

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A patient is scheduled to receive insulin aspart and insulin detemir.
What is the correct procedure for the nurse to draw up the insulins for administration?