The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan?

When mixing insulin, the regular insulin is drawn up into the syringe first.

If two different types of insulin are ordered, they need to be given in separate injections.

There is no need to inject air into the bottle of insulin before withdrawing the insulin.

When mixing insulin, the NPH insulin is drawn up into the syringe first.

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is C

Explanation

Crepitus is a clinical manifestation of bone fragmentation where displaced osseous surfaces rub against one another during movement. This physical finding occurs when the structural integrity of the cortical bone is lost, allowing for friction between irregular edges. In a clinical setting, it is a definitive sign of a displaced fracture and necessitates immediate immobilization to prevent further soft tissue or neurovascular trauma.

A. Bleeding: While internal hemorrhage or hematoma formation frequently accompanies acute fractures, it is not the phenomenon described by the term crepitus. Bleeding results from the rupture of the medullary cavity vessels and the surrounding periosteum. Crepitus refers specifically to the mechanical friction of bone fragments rather than the vascular extravasation of blood into the interstitial space.

B. a closed fracture: A closed fracture is a classification indicating that the skin surface remains intact despite the underlying skeletal disruption. While crepitus can be palpated in both open and closed fractures, the term itself does not define the status of the integument. Identifying crepitus is an assessment finding during palpation, whereas "closed" describes the external presentation of the injury.

C. a crackling sound: Crepitus is characterized by a distinct grating or crackling sensation and sound produced by the rubbing of bone ends. It signifies significant instability at the fracture site and is often associated with intense localized pain. Nurses must avoid purposeful elicitation of this sign to prevent causing secondary injury to the surrounding muscular and nervous tissues.

D. ecchymosis: Ecchymosis refers to the discoloration of the skin resulting from the infiltration of blood into the subcutaneous tissues, commonly known as bruising. It typically appears hours or days after a fracture as blood from the bone marrow migrates toward the surface. Crepitus is a tactile and auditory sensation occurring immediately upon movement, unlike the visual changes of ecchymosis.

A. Levothyroxine B. Cimetidine C. Prednisone D. Cephalexin

Correct Answer is C

Explanation

Glucocorticoids, such as prednisone, are potent insulin antagonists that significantly disrupt carbohydrate metabolism. They stimulate hepatic gluconeogenesis and decrease the sensitivity of skeletal muscle and adipose tissue to insulin. This results in steroid-induced hyperglycemia, which can severely compromise the glycemic control of a client managed with metformin.

A. Levothyroxine: This synthetic thyroid hormone is used to treat hypothyroidism and generally has a minimal impact on blood glucose levels when dosed correctly. While severe hyperthyroidism can increase glucose turnover, therapeutic levothyroxine is not contraindicated for diabetic patients. It does not possess the diabetogenic properties characteristic of high-dose corticosteroids.

B. Cimetidine: Cimetidine is an H2-receptor antagonist that can actually increase metformin levels by competing for renal tubular secretion. While this interaction requires monitoring for metformin toxicity or lactic acidosis, it does not cause the primary contraindication of raising blood glucose. It is a pharmacokinetic interaction rather than a direct metabolic opposition.

C. Prednisone: This corticosteroid is contraindicated or requires extreme caution because it directly promotes hyperglycemia and insulin resistance. For a diabetic client, taking prednisone often necessitates a significant increase in antidiabetic medication or the temporary use of insulin. It acts as a metabolic stressor that actively works against the therapeutic effects of metformin.

D. Cephalexin: This cephalosporin antibiotic is used to treat bacterial infections and does not inherently alter glucose metabolism. While an active infection itself can raise blood sugar through the stress response, the medication Cephalexin does not. It is considered safe and is frequently prescribed to diabetic patients for soft-tissue infections.

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The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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