A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. The nurse knows:

NPH insulin should only be mixed with insulin glargine

These two forms of insulin are not compatible and cannot be mixed

Mixing these two forms of insulin may increase the overall potency of the products

This is an acceptable practice

Answer and Explanation

The Correct Answer is D

Choice A reason: NPH insulin is not mixed with insulin glargine, as glargine’s pH and formulation cause precipitation or altered pharmacokinetics when combined. NPH can be mixed with regular insulin, as they are compatible, making this choice incorrect for the patient’s reported practice.

Choice B reason: NPH and regular insulin are compatible and routinely mixed in one syringe to provide both intermediate and short-acting coverage. They don’t react chemically or lose efficacy when combined properly, making this choice incorrect, as mixing is a standard practice in diabetes management.

Choice C reason: Mixing NPH and regular insulin does not increase potency; it combines their pharmacokinetics for basal and prandial glucose control. The mixture delivers the additive effects of each insulin’s profile without enhancing overall potency, making this choice inaccurate for their combined action.

Choice D reason: Mixing NPH (intermediate-acting) and regular insulin (short-acting) is an accepted practice to manage type 1 diabetes with one injection, covering basal and prandial needs. Proper technique (drawing regular insulin first) ensures stability, making this the correct choice for the patient’s reported insulin administration.

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Correct Answer is D

Explanation

Choice A reason: Insulin does not stimulate the liver to convert glycogen to glucose; instead, it promotes glycogenesis and inhibits glycogenolysis. By facilitating glucose uptake and storage, insulin lowers blood glucose levels, counteracting the process of glycogen breakdown into glucose, which is regulated by glucagon and other hormones, making this choice incorrect.

Choice B reason: Insulin does not promote amino acid synthesis into glucose (gluconeogenesis). It inhibits gluconeogenesis in the liver, reducing glucose production from amino acids and other substrates. By enhancing glucose uptake and storage, insulin maintains glucose homeostasis, making this option incorrect as it misrepresents insulin’s role in glucose metabolism.

Choice C reason: Insulin does not stimulate the pancreas to reabsorb glucose. The pancreas produces insulin, which acts on target tissues like muscle and fat to facilitate glucose uptake. Glucose reabsorption occurs in the kidneys, regulated by sodium-glucose cotransporters, not insulin, making this choice scientifically inaccurate for insulin’s function.

Choice D reason: Insulin promotes glucose uptake into cells by facilitating GLUT4 transporter translocation to cell membranes in muscle and adipose tissue. This allows glucose to enter cells for energy production via glycolysis and the Krebs cycle. This is insulin’s primary role in maintaining blood glucose homeostasis, making it the correct choice for its action.

A. Poor medication compliance B. Increased force of ventricular contraction C. Decreased force of ventricular contraction D. Lack of exercise

Correct Answer is C

Explanation

Choice A reason: Poor medication compliance may worsen heart failure but isn’t directly linked to crackles and shortness of breath. These symptoms result from fluid overload due to reduced cardiac output, not solely non-adherence. This choice is less specific to the physiological cause described.

Choice B reason: Increased ventricular contraction force, as with inotropes like digoxin, improves cardiac output, reducing fluid backup. Crackles and shortness of breath indicate fluid overload from poor heart function, not enhanced contraction, making this choice incorrect for the symptoms’ cause.

Choice C reason: Decreased ventricular contraction force in heart failure reduces cardiac output, causing blood to back up into the lungs, leading to pulmonary edema. This manifests as crackles and shortness of breath due to fluid accumulation, making this the correct physiological explanation for the symptoms.

Choice D reason: Lack of exercise may contribute to overall heart failure progression but doesn’t directly cause crackles and shortness of breath. These symptoms stem from acute fluid overload due to impaired cardiac pumping, not deconditioning, making this choice incorrect for the immediate cause.

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A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. The nurse knows:

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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