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The nurse is instructing a client on the self-administration of insulin. Place in order the steps that the nurse will instruct the client to take.
(Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Stabilize the skin by pinching an area.

Hold the syringe as if holding a pencil.

Insert the needle straight into the skin.

Push the plunger of the syringe.

Pull the needle straight out of the skin.

Press a cotton ball over the injection site.

Discard the syringe into a hard container.

Answer and Explanation

The Correct Answer is B,A,C,D,E,F,G

The self-injection process is designed to ensure the medication is deposited into the subcutaneous fat while minimizing tissue trauma. Proper technique includes stabilization of the site and a perpendicular insertion to reach the correct depth. Post-injection safety, specifically the immediate disposal of the needle, is critical for preventing accidental needlesticks.

Step 1. Hold the syringe as if holding a pencil: This grip provides the necessary manual dexterity and control for a steady insertion. It allows the client to use a quick, dart-like motion which reduces the pain associated with needle penetration. A firm grip is essential for maintaining the 90-degree angle during the procedure.

Step 2. Stabilize the skin by pinching an area: Pinching a fold of skin lifts the subcutaneous tissue away from the underlying muscle. This is especially important in lean individuals to ensure the insulin is not injected into the vascularized muscle, which would cause dangerously rapid absorption. This step provides a stable target for the needle.

Step 3. Insert the needle straight into the skin: A straight, 90-degree insertion ensures the needle bypasses the dermis and reaches the adipose layer. This angle provides the most consistent pharmacokinetic delivery of the hormone. Avoiding a slanted insertion minimizes skin irritation and ensures the entire dose is delivered at the proper depth.

Step 4. Push the plunger of the syringe: The medication should be injected steadily and completely to ensure the full dosage is administered. The client must depress the plunger fully to empty the barrel of the syringe. Maintaining the skin pinch or stabilization during this step ensures the needle does not shift.

Step 5. Pull the needle straight out of the skin: Removing the needle at the same angle it was inserted prevents tissue tearing and discomfort. The needle should be withdrawn quickly after the plunger is fully depressed. This motion minimizes the risk of insulin leakage from the puncture site.

Step 6. Press a cotton ball over the injection site: Applying gentle pressure helps prevent bruising or bleeding from the small puncture. The client should be instructed not to massage the area, as friction can accelerate insulin absorption and lead to hypoglycemia. Simple pressure is sufficient for localized hemostasis.

Step 7. Discard the syringe into a hard container: Immediate disposal in a sharps container prevents injury to the client or others in the household. This is the final step in the safety protocol for biohazardous waste management. It ensures that used needles are never left in the environment where they could cause harm.

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Free Nursing Study Resources

Correct Answer is A

Explanation

The technique of mixing insulin requires a specific sequence to prevent the cross-contamination of vials. Maintaining the purity of short-acting insulin is vital for ensuring pharmacodynamic predictability during mealtime coverage. Improper technique, such as introducing protamine into a clear vial, can cause accidental precipitates or alter the onset of action of the rapid-acting component.

A. When mixing insulin, the regular insulin is drawn up into the syringe first: Drawing the clear, short-acting insulin before the cloudy, intermediate-acting NPH prevents contaminating the regular vial with NPH protein. This "clear to cloudy" sequence ensures the purity and integrity of the fast-acting medication. It is a critical safety step to maintain the correct peak and duration for glycemic control.

B. If two different types of insulin are ordered, they need to be given in separate injections: While some analogs cannot be mixed, regular and NPH are compatible and often combined in one syringe to reduce the number of integumentary punctures. This approach improves patient adherence and minimizes discomfort during daily medication administration. Providing separate injections is unnecessary and increases the risk of skin trauma and site irritation.

C. There is no need to inject air into the bottle of insulin before withdrawing the insulin: Insulin vials are closed systems, so injecting an amount of air equal to the dose is necessary to prevent a vacuum from forming. A vacuum makes it difficult to withdraw the precise volume of medication needed. Proper displacement of fluid with air ensures accurate dosing and facilitates easier withdrawal of the hormone.

D. When mixing insulin, the NPH insulin is drawn up into the syringe first: Drawing NPH first risks the transfer of protamine into the regular insulin vial, which would neutralize its rapid-acting properties. This error compromises the clinical efficacy of the preprandial dose. The correct sequence is always to withdraw the clear insulin first to avoid altering the molecular structure of the regular insulin.

A. Lose weight, if obese B. Undergo eye examinations regularly C. Stop using tobacco in any form D. Have blood glucose levels checked annually

Correct Answer is A

Explanation

Type 2 diabetes is strongly linked to metabolic syndrome, where excess visceral fat increases the production of inflammatory cytokines. These substances interfere with insulin signaling pathways, leading to systemic resistance. Reducing body mass, particularly around the midsection, is the most effective way to restore insulin sensitivity and normalize blood glucose levels.

A. Lose weight, if obese: Obesity is the single most significant modifiable risk factor for the development of insulin resistance. Achieving a 5% to 7% reduction in body weight has been clinically proven to reduce the risk of progressing to type 2 diabetes. This intervention directly addresses the pathophysiology of the disease rather than just monitoring its complications.

B. Undergo eye examinations regularly: Retinal screening is a tertiary prevention strategy aimed at detecting diabetic retinopathy once the disease is already present. It does nothing to reduce the physiological risk of developing the metabolic disorder itself. While essential for preventing blindness, it is a management tool for established diabetics, not a primary prevention action.

C. Stop using tobacco in any form: Tobacco use is a major cardiovascular risk factor and can worsen insulin resistance, but its impact is less direct than obesity. While smoking cessation is vital for overall health and reducing macrovascular complications, it is not the primary driver of glucose intolerance. Weight management remains the higher priority for reducing the incidence of diabetes.

D. Have blood glucose levels checked annually: Annual screening is a secondary prevention measure designed for early detection and diagnosis. While it helps in identifying prediabetes early, the act of checking blood sugar does not physically reduce the body's risk of developing the condition. It is a surveillance tool rather than an active lifestyle intervention that alters disease progression.

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The nurse is instructing a client on the self-administration of insulin. Place in order the steps that the nurse will instruct the client to take. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Nursing Test Bank

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Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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The nurse is instructing a client on the self-administration of insulin. Place in order the steps that the nurse will instruct the client to take.
(Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)