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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
COPD (Chronic Obstructive Pulmonary Disease) is a chronic lung disease that causes airflow obstruction. While labetalol can cause some bronchoconstriction, it is generally considered safe for use in patients with COPD. However, it's essential to monitor respiratory status closely, especially in those with severe COPD.
Choice B rationale:
Narrow-angle glaucoma is an eye condition characterized by increased intraocular pressure (IOP) due to impaired drainage of aqueous humor. Labetalol can exacerbate this condition by further increasing IOP through its beta-blocking effects. This can lead to acute angle-closure glaucoma, a medical emergency that can result in permanent vision loss.
Specific mechanisms by which labetalol can increase IOP:
Reduced aqueous humor production: Beta-blockers like labetalol can decrease the production of aqueous humor, the fluid that maintains eye pressure. While this might seem beneficial, a significant reduction can lead to anterior chamber shallowing, which can mechanically block the drainage angle and trigger angle closure.
Impaired uveoscleral outflow: Beta-blockers can also impair the uveoscleral outflow pathway, an alternative route for aqueous humor drainage that becomes more important in glaucoma patients. This can further contribute to IOP elevation.
Vasoconstriction of ciliary blood vessels: Labetalol's alpha-blocking effects can cause vasoconstriction of the ciliary blood vessels, which supply blood to the ciliary body responsible for aqueous humor production. This can reduce blood flow and indirectly hinder aqueous humor drainage.
Pupillary dilation: Beta-blockers can cause pupillary dilation, which can mechanically narrow the anterior chamber angle and obstruct aqueous humor outflow.
Therefore, labetalol is generally contraindicated in patients with known narrow-angle glaucoma.
Choice C rationale:
Hypertension (high blood pressure) is one of the primary indications for labetalol. It is an effective antihypertensive medication that works by blocking beta receptors, leading to decreased heart rate, contractility, and blood pressure.
Choice D rationale:
Tachycardia (fast heart rate) can also be treated with labetalol due to its beta-blocking effects. It helps to slow down the heart rate and restore a normal rhythm.
Correct Answer is D
Explanation
Choice A rationale:
Fava beans do not interact with antithyroid medications and do not need to be avoided specifically for this reason. However, it's important to note that fava beans can cause a condition called favism in individuals with a certain genetic predisposition. Favism is characterized by hemolytic anemia, which is the breakdown of red blood cells. If a patient has a history of favism or is unsure of their risk, it's best to avoid fava beans while on antithyroid medication and consult with their healthcare provider.
Choice B rationale:
Shellfish does not typically interact with antithyroid medications. However, some individuals with hyperthyroidism may have co-existing allergies to shellfish. In those cases, it's important to avoid shellfish to prevent allergic reactions, but this is not due to a direct interaction with antithyroid medications.
Choice C rationale:
Foods high in purine, such as organ meats, red meat, and certain seafood, are often restricted in individuals with gout. Gout is a form of arthritis caused by the buildup of uric acid crystals in the joints. While hyperthyroidism can sometimes increase uric acid levels, there's no specific interaction between antithyroid medications and purine-rich foods. Therefore, avoiding purine- rich foods is not necessary for those on antithyroid therapy unless they have gout or a predisposition to it.
Choice D rationale:
Grapefruit and grapefruit juice can significantly interact with antithyroid medications, particularly methimazole and propylthiouracil. These medications are broken down by an enzyme called CYP3A4 in the liver. Grapefruit juice inhibits the activity of CYP3A4, which can lead to increased levels of antithyroid medications in the bloodstream. This can increase the risk of side effects from the medication, such as liver damage, bone marrow suppression, and skin reactions. Therefore, it's crucial for patients on antithyroid therapy to avoid grapefruit and grapefruit juice.
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