The nurse in the emergency department is caring for a client with diabetic ketoacidosis and has the following prescriptions. Which of these prescriptions should the nurse clarify?

Regular insulin IV at 0.1 unit/kg/hr

5% dextrose in water 100 mL/hour

Arterial blood gases every 2 hours

Mix insulin in 0.9% normal saline solution

Answer and Explanation

The Correct Answer is B

A. Regular insulin IV at 0.1 unit/kg/hr is a standard prescription for managing diabetic ketoacidosis (DKA). Regular insulin is administered intravenously to reduce blood glucose and correct the acidosis in DKA.
B. The nurse should clarify this prescription. In the initial management of DKA, the focus is on correcting fluid deficits, and a typical intravenous fluid for this purpose is 0.9% normal saline (not dextrose). Once blood glucose levels start to decrease and are near 200 mg/dL, dextrose may be introduced to prevent hypoglycemia, but it should not be started too early in the treatment of DKA.
C. Monitoring arterial blood gases (ABGs) is crucial in DKA to assess the severity of acidosis and monitor the effectiveness of treatment, typically done every 1 to 2 hours.
D. Regular insulin is typically mixed with 0.9% normal saline for intravenous administration in DKA. This solution helps deliver the insulin slowly and safely while rehydrating the client.

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Correct Answer is D

Explanation

A. Gestational diabetes (GDM) is indeed characterized by insulin resistance, which often worsens as the pregnancy progresses. However, the problem is not always a decrease in endogenous insulin but more of a relative insulin resistance in response to the hormones produced during pregnancy.
B. This description is more fitting for other types of diabetes, such as type 2 diabetes, where certain medications or conditions (like pancreatic disease or hormonal issues) can affect insulin production or action. Gestational diabetes is not typically caused by these factors.
C. Gestational diabetes is not caused by antibodies to insulin. It is a form of diabetes that develops during pregnancy due to hormonal changes that lead to insulin resistance. Some women may need insulin therapy to manage it, but this is not due to antibodies to insulin.
D. Gestational diabetes is a type of diabetes where glucose intolerance is often transitory. Gestational diabetes typically develops during pregnancy and often resolves after childbirth. However, women who have had gestational diabetes are at an increased risk of developing type 2 diabetes later in life, even though the condition may resolve postpartum.

A. "Bedtime snacks are provided to prevent hypoglycemic reaction at night." B. "Food should be provided to the client at the peak action time of the insulin." C. "NPH and regular insulin can be combined in one syringe by first drawing up the NPH. D. "Clients should be provided information about hypoglycemia and its management.

Correct Answer is B

Explanation

A. Bedtime snacks are often recommended for clients using insulin to help prevent nighttime hypoglycemia, especially if they are taking insulin that has a peak action during the night (e.g., NPH insulin).
B. The timing of food intake should not necessarily coincide with the peak action of the insulin. For example, rapid-acting insulins should be given around meal times, but the timing of food isn't strictly tied to the insulin peak. It's more important to match the insulin to meal timing to help with glucose control.
C. When mixing NPH (a longer-acting insulin) and regular insulin (a shorter-acting insulin), the correct technique is to draw up the regular insulin first to avoid contamination of the regular insulin with the NPH insulin, which is cloudy.
D. Educating clients about the signs, symptoms, and management of hypoglycemia is essential to safe insulin therapy.

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The nurse in the emergency department is caring for a client with diabetic ketoacidosis and has the following prescriptions. Which of these prescriptions should the nurse clarify?

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Naxlex Comprehensive Predictor Exams

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