The client asks the nurse about storing insulin. Which response by the nurse is correct?

Vials of insulin should be refrigerated.

Insulin will last longer if kept in the freezer.

Opened vials of insulin must be discarded.

Insulin pens never have to be refrigerated.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Insulin is a protein-based hormone that is sensitive to heat and light. Exposure to high temperatures or direct sunlight can cause insulin to break down and become less effective.

Refrigeration helps to maintain the stability and potency of insulin. It is generally recommended to store unopened insulin vials in the refrigerator at a temperature between 36°F and 46°F (2°C and 8°C).

This temperature range helps to slow down the degradation process and ensure that the insulin remains effective until its expiration date.

Choice B rationale:

Insulin should never be frozen. Freezing can cause the insulin to crystallize and become unusable. Once insulin has been frozen, it cannot be thawed and used again.

Choice C rationale:

Opened vials of insulin do not need to be discarded immediately. They can be stored in the refrigerator for up to 28 days, depending on the type of insulin.

However, it is important to note the date that the vial was opened and to discard it after the recommended storage period.

Choice D rationale:

Insulin pens should be stored according to the manufacturer’s instructions. Some insulin pens can be stored at room temperature for a certain period of time, while others must be refrigerated.

It is important to read the instructions that come with the insulin pen to ensure that it is stored properly.

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Correct Answer is C

Explanation

Choice A rationale:

Insulin glargine (Lantus) is a long-acting insulin that does not have any immediate effect on blood glucose levels. It is not typically a concern for patients undergoing CT scans with contrast.

However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving insulin therapy, as the contrast media used in CT scans can sometimes cause hyperglycemia.

Choice B rationale:

Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing the absorption of carbohydrates from the intestines. This can help to reduce blood glucose levels after meals.

Acarbose is not typically a concern for patients undergoing CT scans with contrast. However, it is important to note that acarbose can sometimes cause gastrointestinal side effects, such as bloating, gas, and diarrhea. These side effects may be worsened by the contrast media used in CT scans.

Choice C rationale:

Metformin (Glucophage) is a biguanide that works by reducing glucose production in the liver and increasing insulin sensitivity in the muscles. It is a commonly used medication for the treatment of type 2 diabetes.

Metformin is a concern for patients undergoing CT scans with contrast because it can increase the risk of lactic acidosis. Lactic acidosis is a serious condition that can occur when there is a buildup of lactic acid in the blood. It can be caused by metformin, as well as by other factors such as dehydration, kidney problems, and liver problems.

The contrast media used in CT scans can also increase the risk of lactic acidosis. This is because the contrast media can sometimes cause kidney damage, which can impair the body's ability to remove lactic acid from the blood.

For this reason, metformin is typically discontinued for 48 hours before a CT scan with contrast. It is also important to ensure that patients are well-hydrated before and after the scan.

Choice D rationale:

Glipizide (Glucotrol) is a sulfonylurea that works by stimulating the release of insulin from the pancreas. It is a commonly used medication for the treatment of type 2 diabetes.

Glipizide is not typically a concern for patients undergoing CT scans with contrast. However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving sulfonylurea therapy, as the contrast media used in CT scans can sometimes cause hypoglycemia.

A. Request that if testing is further delayed, the patient will eat lunch first. B. Plan to discontinue the evening dose of insulin. C. Save the lunch tray for the patient’s later return. D. Send a glass of orange juice to the patient in the diagnostic testing area.

Correct Answer is A

Explanation

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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The client asks the nurse about storing insulin. Which response by the nurse is correct?

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Naxlex Comprehensive Predictor Exams

A client with diabetes is scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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