A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension.
Which drug will most likely be ordered for this patient?

Choice A rationale

Administering a medication when there is a strong possibility the patient has already received it could lead to an overdose. The automated dispensing machine's record indicates removal of the dose, and the patient's statement, despite her confusion, suggests she might have taken it. The nurse's primary responsibility is patient safety and preventing medication errors, which this action would violate.

Choice B rationale

This is the safest course of action. The medication was removed from the machine, and the patient states she thinks she took it. The night shift nurse's failure to sign the MAR is a documentation error, but the potential for a double dose is a serious safety concern. The nurse should hold the dose and investigate further before administering anything to prevent an iatrogenic event.

Choice C rationale

Notifying the provider for a new order is an unnecessary and premature step. The issue is not that the medication is unavailable or the order is incorrect. The immediate concern is whether the patient has already received the dose. Holding the medication and verifying the administration is the correct first step, and the provider would not be contacted unless there was a clinical reason to do so, such as if the blood glucose became dangerously high.

Choice D rationale

Giving the insulin and then monitoring the patient is dangerous. Administering an additional dose of insulin could cause a severe hypoglycemic event, especially in a confused patient. The blood glucose of 142 mg/dL is not critically high, so there is no immediate need for the insulin, and the risk of a medication error outweighs any perceived benefit of administering the medication immediately.

Choice A rationale

Insulin lispro is a rapid-acting insulin. It is used to cover mealtime blood sugar spikes due to its rapid onset of action, typically within 15 to 30 minutes, and a short duration of action of approximately 3 to 5 hours.

Choice B rationale

Insulin glargine (Lantus) is a long-acting insulin. It has a slow, sustained absorption and provides a relatively constant basal insulin level over 24 hours with no pronounced peak. This makes it ideal for controlling blood sugar between meals and overnight.

Choice C rationale

Insulin aspart (Novolog) is another rapid-acting insulin. It is designed to be injected just before or at mealtime to quickly control the rise in blood glucose levels that occurs after eating. Its onset is rapid, and its duration is short.

Choice D rationale

Regular insulin is a short-acting insulin. It is often used for mealtime coverage, but its slower onset (30 to 60 minutes) and peak (2 to 4 hours) make it less flexible than rapid-acting insulins. It is also used in insulin drips for acute management.