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 B
Explanation
Rationale for Choice A:
Repeating the dose of nitroglycerin SL is not recommended at this time due to the patient's hypotension (blood pressure of 88/68 mmHg).
Administering additional nitroglycerin could further lower the blood pressure, potentially leading to adverse consequences such as dizziness, lightheadedness, or even fainting.
It's crucial to prioritize patient safety and avoid actions that could exacerbate their condition. Rationale for Choice B:
Notifying the provider is the most appropriate action in this situation for several reasons:
The patient's chest pain has not been relieved by the initial dose of nitroglycerin, indicating a need for further evaluation and potential adjustments to the treatment plan.
The patient's blood pressure is low, which warrants close monitoring and possible intervention to prevent complications.
The provider can assess the patient's overall clinical picture, including other symptoms and medical history, to determine the best course of action.
Early notification allows for timely interventions and potential prevention of further complications. Rationale for Choice C:
While nitroglycerin by translingual spray may be considered in some cases of persistent angina, it's not the most appropriate choice in this situation due to the patient's hypotension.
The translingual spray can also have a rapid onset of action, which might further lower the blood pressure if not carefully monitored.
It's essential to consider the patient's overall hemodynamic status before administering any medication that could potentially affect blood pressure.
Rationale for Choice D:
Administering NPH insulin is not relevant to the management of angina or chest pain.
Insulin is used to treat hyperglycemia in patients with diabetes, and its administration would not address the underlying issue of the patient's chest pain.
It's important to select interventions that are directly targeted at the patient's presenting symptoms and condition.
Correct Answer is C
Explanation
Choice A rationale:
Fever is not a common side effect of metformin. While it's possible for a minority of patients to experience a mild fever as their bodies adjust to the medication, it's not considered a typical or expected adverse effect.
Fevers typically occur due to infections or inflammation, and metformin does not directly cause either of these processes.
If a patient taking metformin develops a fever, it's crucial to rule out other potential causes, such as infections or other medications, before attributing it to metformin.
Choice B rationale:
Insomnia is also not a common side effect of metformin. In fact, some studies have suggested that metformin may even have a positive effect on sleep quality in some individuals.
While sleep disturbances can occur with any medication, they are not specifically associated with metformin.
If a patient experiences insomnia while taking metformin, it's essential to consider other potential factors, such as stress, anxiety, or other medications, that could be contributing to sleep problems.
Choice C rationale:
Bitter or metallic taste is a very common side effect of metformin, experienced by approximately 30-40% of patients. This taste disturbance is thought to be caused by metformin's interaction with taste receptors on the tongue.
The taste is often described as metallic, bitter, or similar to the taste of pennies.
While it can be unpleasant, it's generally not considered a serious side effect and does not usually require discontinuation of the medication.
Some strategies to manage the metallic taste include: Taking metformin with meals or snacks to mask the taste.
Chewing sugar-free gum or sucking on hard candy after taking the medication. Rinsing the mouth with water or mouthwash after taking the medication.
Switching to an extended-release formulation of metformin, which may have a less pronounced metallic taste.
Choice D rationale:
Seizures are a rare but serious side effect of metformin.
They are most likely to occur in patients with underlying kidney problems or those taking certain other medications that can interact with metformin.
If a patient taking metformin experiences a seizure, it's critical to seek immediate medical attention.
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