The nurse is aware that which insulins are long-acting and should be administered once daily at bedtime? (Select all that apply.)
Insulin glargine (Lantus)
Lispro (Humalog)
Insulin detemir (Levemir)
Correct Answer : A,C
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin analog that is designed to provide a steady, basal level of insulin throughout the day.
It has a duration of action of approximately 24 hours, so it is typically administered once daily at bedtime.
This helps to control blood glucose levels overnight and during the early morning hours, when the risk of hypoglycemia is highest.
Key characteristics of Insulin Glargine (Lantus):
Onset: 1-2 hours
Peak: No pronounced peak Duration: Approximately 24 hours
Administration: Once daily at bedtime
Choice B rationale:
Lispro (Humalog) is a rapid-acting insulin analog that is designed to be taken with meals to help control blood glucose spikes after eating.
It has a onset of action of approximately 15 minutes and a duration of action of 2-4 hours.
Because of its rapid onset and short duration of action, lispro is not typically used as a basal insulin. Key characteristics of Lispro (Humalog):
Onset: 15 minutes
Peak: 30-90 minutes
Duration: 2-4 hours
Administration: With meals
Choice C rationale:
Insulin detemir (Levemir) is another long-acting insulin analog that is similar to insulin glargine in terms of its duration of action.
It is typically administered once daily at bedtime to provide basal insulin coverage. Key characteristics of Insulin Detemir (Levemir):
Onset: 1-2 hours
Peak: No pronounced peak
Duration: Approximately 18-24 hours Administration: Once daily at bedtime Question 23.
The nurse receives an order for insulin: NPH (Humulin NPH) 10 units to be administered intravenously daily at 7:00am.
What action should the nurse take?
A. Administer the dose but ensure that if mixed with another Humulin-R insulin, to draw the regular insulin up first.
B. Give the drug subcutaneously rather than IV
C. Review the insulin order with the prescriber and pharmacy.
D. Administer the insulin ordered mixed in 50 ML of 0.9%NS IV Piggyback (not to infuse faster than 1/2 hour or 30 minutes).
The correct answer is C. Review the insulin order with the prescriber and pharmacy.
Rationale for Choice A:
Intravenous administration of NPH insulin is not recommended. It is an intermediate-acting insulin that is designed to be absorbed slowly from the subcutaneous tissue. IV administration can lead to rapid and unpredictable changes in blood glucose levels, which can be dangerous.
Mixing NPH insulin with regular insulin does not change the route of administration. Both insulins should still be given subcutaneously.
Rationale for Choice B:
Subcutaneous administration of NPH insulin is the correct route. This allows for slow and steady absorption of the insulin, which helps to prevent blood glucose fluctuations.
However, the nurse should still clarify the order with the prescriber and pharmacy. This is because IV insulin orders are unusual and may be a mistake.
Rationale for Choice D:
Adding NPH insulin to a 50 mL IV piggyback is not a safe practice. This would dilute the insulin and make it even more difficult to control the rate of infusion.
IV insulin infusions are typically administered using a dedicated insulin pump. This allows for precise control of the infusion rate and helps to prevent hypoglycemia.
Rationale for Choice C:
Reviewing the insulin order with the prescriber and pharmacy is the safest course of action. This will help to ensure that the order is correct and that the insulin is administered safely.
The prescriber may have meant to order regular insulin instead of NPH insulin. Regular insulin can be given intravenously, but it requires careful monitoring of blood glucose levels.
The pharmacy can also double-check the order and ensure that the correct insulin is dispensed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
NPH insulin is an intermediate-acting insulin that typically peaks 6-12 hours after administration.
Given that the insulin was administered at 1700 (5:00 PM), the peak action would be expected to occur between 2100 (9:00 PM) and 0500 (5:00 AM).
This time frame aligns with the known pharmacokinetics of NPH insulin.
It's crucial for nurses to be aware of the peak action times of different insulin types to effectively manage blood glucose levels and adjust insulin doses accordingly.
Choice B rationale:
Incorrect. NPH insulin does have a peak action, as explained above.
It's important to understand that even intermediate-acting insulins have a period of peak activity when they exert their strongest glucose-lowering effect.
Choice C rationale:
Incorrect. This time frame is too early to represent the peak action of NPH insulin. The peak action typically occurs later, between 6-12 hours after administration.
Choice D rationale:
Incorrect. This time point is too specific to accurately represent the peak action of NPH insulin.
The peak action can vary within the 6-12 hour window, depending on individual factors and injection site.
Correct Answer is C
Explanation
Choice A rationale:
Insulin resistance is a condition in which the body's cells become less responsive to insulin, requiring more insulin to maintain normal blood glucose levels.
It's primarily caused by factors such as obesity, physical inactivity, and genetic predisposition. Rotating injection sites does not directly address these underlying causes of insulin resistance.
It can help ensure consistent insulin absorption, but it's not the primary mechanism for preventing insulin resistance.
Choice B rationale:
Allergic reactions to insulin are rare but can occur.
They typically manifest as localized symptoms at the injection site, such as redness, swelling, itching, or pain.
In severe cases, systemic reactions like hives, difficulty breathing, or anaphylaxis can occur.
Rotating injection sites might reduce the risk of localized allergic reactions by preventing repeated exposure to insulin in the same area of skin.
However, it does not prevent systemic allergic reactions, which are immune-mediated and not dependent on the injection site.
Choice C rationale:
Lipodystrophy is a condition characterized by abnormal changes in fat distribution under the skin. It can occur as a complication of repeated insulin injections at the same site.
There are two main types of lipodystrophy:
Lipohypertrophy: This involves the accumulation of excess fatty tissue at injection sites, creating visible lumps or bumps. Lipoatrophy: This involves the loss of fatty tissue at injection sites, leading to depressions or indentations in the skin.
Both lipohypertrophy and lipoatrophy can interfere with insulin absorption, leading to unpredictable blood glucose control.
Rotating injection sites helps to prevent lipodystrophy by distributing insulin injections over a wider area of skin, reducing the likelihood of repeated trauma to the same tissue.
Choice D rationale:
Insulin shock, also known as hypoglycemia, is a condition that occurs when blood glucose levels drop too low.
It can be caused by several factors, including excessive insulin dosing, missed meals, or increased physical activity. Rotating injection sites does not directly affect the risk of insulin shock.
It's essential for individuals using insulin to monitor their blood glucose levels regularly, adjust insulin doses as needed, and follow a balanced diet and exercise plan to prevent hypoglycemia.
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