The nurse is instructing a patient on home administration of insulin.
The patient’s discharge instructions indicate that regular (Humulin R) and NPH (Humulin NPH) insulin should be administered at 0700 every day.
What is an important teaching point for this patient?
Draw up the medications after mixing them in a vial.
Inject the insulin into the buttocks only since this is a mixed insulin.
Draw up the NPH insulin first.
Draw up the regular insulin first.
The Correct Answer is D
Choice A rationale:
Mixing insulins in a vial is generally not recommended unless specifically instructed by the healthcare provider. It can alter the effectiveness of the insulins and increase the risk of dosage errors.
Premixed insulins, which are already combined in a specific ratio, are available if a combination of insulins is needed.
However, in this case, the patient is instructed to administer regular and NPH insulin separately, indicating that they should not be mixed in a vial.
Choice B rationale:
Insulin can be injected into various subcutaneous sites, including the abdomen, thighs, upper arms, and buttocks.
There is no specific requirement to inject mixed insulin into the buttocks only.
The choice of injection site can be based on individual preferences, absorption rates, and the presence of lipohypertrophy (thickening of the subcutaneous tissue due to repeated injections).
Choice C rationale:
Drawing up NPH insulin first could lead to contamination of the regular insulin vial with NPH insulin.
NPH insulin is a suspension, and drawing it up first could introduce some of its particles into the regular insulin vial, potentially altering its absorption and action profile.
Choice D rationale:
It's crucial to draw up the regular insulin first to prevent contamination of the regular insulin vial with NPH insulin. The following steps outline the correct procedure:
Wash hands thoroughly with soap and water.
Inspect the insulin vials for clarity, expiration date, and any damage.
Roll the NPH insulin vial gently between the palms to resuspend the insulin particles (if applicable). Wipe the rubber stoppers of both vials with an alcohol swab.
Using a sterile syringe, withdraw air into the syringe equal to the amount of regular insulin to be drawn.
Inject the air into the regular insulin vial, keeping the needle tip above the fluid level to avoid creating bubbles. Invert the regular insulin vial and withdraw the prescribed dose of regular insulin.
Without injecting air into the NPH insulin vial, withdraw the prescribed dose of NPH insulin. Administer the insulin as directed, using proper injection technique.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Erythromycin ointment does not have moisturizing properties. Its primary function is to act as an antibiotic to prevent bacterial infections.
While it may have a slightly lubricating effect due to its ointment base, this is not its intended purpose.
If moisture is the primary goal, artificial tears or other ophthalmic lubricants would be more appropriate choices.
Choice B rationale:
Chemical conjunctivitis is typically caused by irritants such as chlorine, smoke, or chemicals, not bacteria. Erythromycin is not effective in preventing or treating chemical conjunctivitis.
Treatment for chemical conjunctivitis usually involves flushing the eyes with saline or water and applying cool compresses, as well as potentially using topical antihistamines or corticosteroids to reduce inflammation.
Choice D rationale:
Erythromycin ointment is not typically used to treat active eye infections in newborns.
While it can be used for this purpose in certain cases, it is more commonly used as a prophylactic measure to prevent infections from developing in the first place.
If a newborn has a suspected eye infection, a healthcare provider would likely collect a sample of discharge for testing and culture to determine the specific causative organism and select the most appropriate antibiotic treatment.
Choice C rationale:
The primary purpose of applying erythromycin ointment to a newborn's eyes is to prevent bacterial eye infections, specifically ophthalmia neonatorum.
Ophthalmia neonatorum is a serious condition that can lead to vision loss if not treated promptly.
It is most commonly caused by the bacteria Neisseria gonorrhoeae and Chlamydia trachomatis, which can be transmitted to the newborn during childbirth if the mother is infected.
Erythromycin ointment is effective in preventing these infections by killing or inhibiting the growth of these bacteria. It is typically applied to the newborn's eyes within 1 hour of birth as a standard practice in many countries.
Correct Answer is A
Explanation
Choice A rationale:
Hypoglycemia is a critical consideration: The patient's symptoms of lethargy, diaphoresis, and combativeness, along with recent insulin administration, raise a strong suspicion of hypoglycemia (low blood sugar). Hypoglycemia can quickly progress to coma and seizures if not promptly treated, making it a high priority to assess and address.
Bedside glucose testing is rapid and reliable: A bedside finger stick blood glucose test is a quick, non-invasive, and accurate way to determine the patient's blood sugar level. It provides immediate results, allowing for prompt intervention if hypoglycemia is confirmed.
Other assessments and interventions can follow: Once hypoglycemia is ruled out or confirmed, the nurse can proceed with other assessments and interventions as needed.
Choice B rationale:
Insulin administration without blood sugar confirmation is dangerous: Administering insulin without first checking the patient's blood sugar could worsen hypoglycemia if it is already present. This could lead to severe complications, including neurological damage or even death.
Insulin timing is not a priority: While the next dose of insulin may be due, its administration is not the most urgent priority in this situation. Addressing the patient's immediate symptoms and potential hypoglycemia takes precedence.
Choice C rationale:
Naloxone is not indicated for hypoglycemia: Naloxone is an opioid antagonist used to reverse opioid overdose. It has no effect on hypoglycemia and would not be appropriate in this case.
Choice D rationale:
Oxygen therapy may not address the underlying issue: While oxygen therapy can be beneficial for patients with respiratory distress, it does not address the potential hypoglycemia in this case. If the patient's lethargy and combativeness are due to low blood sugar, oxygen therapy alone would not be sufficient treatment.
Oxygen saturation is already within normal limits: The patient's oxygen saturation (SPO2) is 97%, indicating that their oxygenation is currently adequate. Oxygen therapy would not be indicated unless there were signs of hypoxia.
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