What specific administration techniques should the nurse employ when administering NPH insulin?
Never mix with another insulin.
Roll the vial gently to mix the suspension.
Only administer this insulin at bedtime.
When mixing with another insulin, draw the NPH into the syringe first.
The Correct Answer is B
Choice A Rationale:
NPH insulin can be mixed with certain other insulins, such as regular insulin, to achieve different effects and better control blood glucose levels. Therefore, stating that it should never be mixed with another insulin is incorrect.
Choice C rationale:
NPH insulin is an intermediate-acting insulin that can be administered at various times of the day, depending on the individual's needs and blood glucose patterns. It is not restricted to bedtime administration only.
Choice D rationale:
When mixing NPH insulin with another insulin, the order of mixing does not significantly affect its action. The crucial aspect is to ensure proper mixing of the insulins before administration.
Choice B rationale:
NPH insulin is a suspension, meaning the insulin particles are not fully dissolved in the liquid. Therefore, it's essential to roll the vial gently between the palms to evenly distribute the insulin particles throughout the solution. This ensures that the patient receives the correct dose and prevents injection of an uneven mixture, which could lead to unpredictable blood glucose levels.
Key points to remember:
NPH insulin is an intermediate-acting insulin that starts working within 1 to 2 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours.
It can be mixed with regular insulin to provide both short-acting and longer-acting insulin coverage. Always follow the specific instructions provided by the insulin manufacturer and healthcare provider. Proper mixing of NPH insulin is crucial for accurate dosing and optimal glucose control.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Rationale for Choice A: Nitroglycerin IV gtt, titrate for SBP > 180mmHg
Mechanism of action: Nitroglycerin is a potent vasodilator that acts primarily on veins, but also has some arterial vasodilatory effects. It relaxes vascular smooth muscle by stimulating the production of nitric oxide, which causes vasodilation. This decrease in preload (venous return to the heart) and afterload (resistance against which the heart pumps) leads to a reduction in blood pressure.
Indications: Nitroglycerin is a preferred agent for hypertensive emergencies associated with acute heart failure, acute coronary syndromes, and aortic dissection. It is also effective in hypertensive emergencies with elevated intracranial pressure.
Dosage and administration: Nitroglycerin is typically administered as an intravenous infusion, starting at a low dose and titrating up based on blood pressure response. The goal is to titrate the medication to maintain systolic blood pressure below 180 mmHg.
Contraindications: Nitroglycerin is contraindicated in patients with a known hypersensitivity to nitrates, severe hypotension (systolic blood pressure < 90 mmHg), or those who have recently used phosphodiesterase-5 inhibitors (such as sildenafil).
Monitoring: During nitroglycerin infusion, it's essential to monitor blood pressure closely, as well as heart rate, for any signs of hypotension or tachycardia.
Rationale for Choice B: Labetalol (Normodyne) 10mg IVP q 10 minutes prn for SBP >170 mmHg
Mechanism of action: Labetalol is a mixed alpha- and beta-adrenergic blocker. It blocks the effects of norepinephrine and epinephrine, leading to vasodilation and a decrease in heart rate.
Indications: Labetalol is a versatile agent that can be used in various hypertensive emergencies, including those associated with acute aortic dissection, acute coronary syndromes, and pre-eclampsia/eclampsia. It's also useful in patients with a history of asthma or chronic obstructive pulmonary disease (COPD), as it has less bronchoconstrictive effects than beta-blockers like propranolol.
Dosage and administration: Labetalol can be administered as an intravenous bolus or infusion. In this scenario, it's prescribed as a 10mg intravenous push every 10 minutes as needed for systolic blood pressure greater than 170 mmHg.
Contraindications: Labetalol is contraindicated in patients with severe bradycardia, heart block, cardiogenic shock, or decompensated heart failure.
Monitoring: During labetalol administration, it's important to monitor blood pressure, heart rate, and electrocardiogram (ECG) for any signs of bradycardia, heart block, or other arrythmias.
Rationale for Choice D: Nitroprusside (Nitropress) IV gtt titrate to keep SBP < 160 mmHg
Mechanism of action: Nitroprusside is a potent vasodilator that acts directly on both arterioles and veins. It relaxes vascular smooth muscle by releasing nitric oxide, leading to a rapid and profound decrease in blood pressure.
Indications: Nitroprusside is often reserved for hypertensive emergencies that are refractory to other agents or those that require rapid blood pressure control, such as hypertensive encephalopathy or acute aortic dissection.
Dosage and administration: Nitroprusside is administered as an intravenous infusion and titrated to the desired blood pressure response. The goal is to keep systolic blood pressure below 160 mmHg.
Contraindications: Nitroprusside is contraindicated in patients with severe renal impairment or those with increased intracranial pressure.
Monitoring: Nitroprusside therapy requires close monitoring of blood pressure, as well as monitoring for thiocyanate toxicity (a metabolite of nitroprusside) in patients with prolonged infusion or renal impairment.
Correct Answer is B
Explanation
Choice A rationale:
Requesting an order for morphine sulfate IV 2 mg over 1-5 minutes would not be appropriate at this time for several reasons: The patient has already received a dose of 4 mg 15 minutes ago, and it has not been effective in relieving the chest pain.
The patient is showing signs of increased respiratory effort, which could be a sign of respiratory depression. Administering an additional dose of morphine could worsen the respiratory depression.
The patient's heart rate is 82 beats per minute, which is within the normal range.
The patient's blood pressure is 135/88 mm Hg, which is also within the normal range.
Choice C rationale:
Administering naloxone (Narcan) to counteract respiratory depression would not be appropriate at this time because the patient is not showing signs of severe respiratory depression. Naloxone is a medication that is used to reverse the effects of opioid overdose. It is typically only used in situations where the patient is experiencing life-threatening respiratory depression.
Choice D rationale:
Administering morphine sulfate IV 4 mg over 1-5 minutes would not be appropriate for the reasons listed above. It could worsen the patient's respiratory depression and potentially lead to other complications.
Choice B is the best answer because it is the most conservative and safest option. By withholding the next dose of morphine and informing the provider about the patient's symptoms, the nurse can ensure that the patient receives the appropriate care and that any potential complications are avoided.
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