A patient with diabetes has been administered 38 units of NPH insulin at 7:00 AM. By 1:00 PM, the patient has been away from the nursing unit for 2 hours and missed lunch while waiting for a chest X-ray.
What is the most appropriate action for the nurse to prevent hypoglycemia?
Request that if testing is further delayed, the patient will eat lunch first.
Plan to discontinue the evening dose of insulin.
Save the lunch tray for the patient’s later return.
Send a glass of orange juice to the patient in the diagnostic testing area.
The Correct Answer is A
Choice A rationale:
Requesting that the patient eat lunch first if testing is further delayed is the most appropriate action to prevent hypoglycemia for the following reasons:
1. Timing of NPH Insulin Peak:
NPH insulin is an intermediate-acting insulin with a peak action time of 4-12 hours after administration.
In this case, the patient received NPH insulin at 7:00 AM, meaning its peak effect is likely to occur between 11:00 AM and 5:00 PM.
Delaying lunch beyond 1:00 PM significantly increases the risk of hypoglycemia as the insulin's action peaks without adequate food intake to balance glucose levels.
2. Ensuring Consistent Mealtimes:
Consistency in meal timing is crucial for managing blood glucose levels in diabetic patients. Delaying meals can disrupt the balance between insulin and glucose, leading to hypoglycemia.
Prioritizing lunch at the usual time, even amidst testing delays, helps maintain a more predictable glucose pattern.
3. Addressing Acute Hypoglycemia Risk:
Hypoglycemia is a serious complication of diabetes that can occur if blood glucose levels fall too low. Symptoms can include shakiness, sweating, dizziness, confusion, and even loss of consciousness.
Promptly addressing potential delays in food intake is essential to prevent hypoglycemia and its associated risks.
Rationales for other choices:
Choice B: Discontinuing the evening dose of insulin does not address the immediate risk of hypoglycemia due to the missed lunch. It could lead to hyperglycemia later in the day or overnight.
Choice C: Saving the lunch tray for later may not be feasible if testing is significantly delayed. It also does not prevent hypoglycemia in the immediate timeframe.
Choice D: While a glass of orange juice can provide a quick source of glucose, it is a short-term solution and does not replace a balanced meal. It could also lead to a rapid rise in blood glucose followed by a subsequent drop.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Severe acidemia: A pH of 6.9 indicates severe acidemia, a condition where the blood is too acidic. Sodium bicarbonate is an alkalizing agent that can help raise the blood pH back to a normal range.
Rapid correction: Intravenous (IVP) administration of sodium bicarbonate allows for rapid correction of acidemia, which is crucial in severe cases to prevent life-threatening complications.
Buffering action: Sodium bicarbonate acts as a buffer, accepting excess hydrogen ions (H+) in the blood and converting them into water and carbon dioxide (CO2), which can be exhaled.
Specific indications: Sodium bicarbonate is typically used in cases of severe acidemia caused by metabolic acidosis, such as diabetic ketoacidosis or lactic acidosis. It may also be considered in cases of respiratory acidosis, but other interventions like ventilatory support are often prioritized.
Choice B rationale:
Calcium carbonate is not a direct treatment for acidemia: It is primarily used as an antacid to neutralize stomach acid and as a calcium supplement for bone health. While it can have a mild alkalizing effect, it is not as effective as sodium bicarbonate in rapidly correcting severe acidemia.
Choice C rationale:
Alkalemia: A pH of 7.6 indicates alkalemia, a condition where the blood is too alkaline. Administration of sodium bicarbonate in this situation would worsen the alkalemia and potentially lead to serious complications.
Choice D rationale:
Hyponatremia: Low serum sodium levels do not directly require treatment with sodium bicarbonate. Sodium bicarbonate is primarily used to address acid-base imbalances, not electrolyte imbalances.
Correct Answer is B
Explanation
Rationale for Choice A:
Repeating the dose of nitroglycerin SL is not recommended at this time due to the patient's hypotension (blood pressure of 88/68 mmHg).
Administering additional nitroglycerin could further lower the blood pressure, potentially leading to adverse consequences such as dizziness, lightheadedness, or even fainting.
It's crucial to prioritize patient safety and avoid actions that could exacerbate their condition. Rationale for Choice B:
Notifying the provider is the most appropriate action in this situation for several reasons:
The patient's chest pain has not been relieved by the initial dose of nitroglycerin, indicating a need for further evaluation and potential adjustments to the treatment plan.
The patient's blood pressure is low, which warrants close monitoring and possible intervention to prevent complications.
The provider can assess the patient's overall clinical picture, including other symptoms and medical history, to determine the best course of action.
Early notification allows for timely interventions and potential prevention of further complications. Rationale for Choice C:
While nitroglycerin by translingual spray may be considered in some cases of persistent angina, it's not the most appropriate choice in this situation due to the patient's hypotension.
The translingual spray can also have a rapid onset of action, which might further lower the blood pressure if not carefully monitored.
It's essential to consider the patient's overall hemodynamic status before administering any medication that could potentially affect blood pressure.
Rationale for Choice D:
Administering NPH insulin is not relevant to the management of angina or chest pain.
Insulin is used to treat hyperglycemia in patients with diabetes, and its administration would not address the underlying issue of the patient's chest pain.
It's important to select interventions that are directly targeted at the patient's presenting symptoms and condition.
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