Saunders NCLEX Insulin questions
A client received a dose of regular insulin (Humulin R) this morning at 7:00 a.m. At what approximate time would the nurse likely anticipate the potential for a hypoglycemic reaction to occur? A. 8:00 a.m. B. 10:00 a.m. C. 12:00 p.m. D. 2:00 p.m.
B. 10:00 a.m. Humulin R is a rapid-acting insulin with a peak action of 2 to 4 hours after injection. Hypoglycemic reactions are most likely to occur during the peak action of insulin, which would be between 10:00 am and 12:00 noon in this situation. This makes 10:00 a.m. the correct option.
Regular insulin is prescribed for a child diagnosed with type 1 diabetes mellitus. The nurse is planning a teaching session with the child and mother about the onset, peak, and duration times of the insulin. Which information should the nurse provide about this type of insulin? A. Onset of 1 hour from injection time, peak of 30 to 90 minutes later, and duration time of 5 hours B. Onset of 30 minutes from injection time, peak of 2 to 4 hours later, and duration time of 4 to 8 hours C. Onset of 2 to 6 hours from injection time, peak of 4 to 14 hours later, and duration time of 14 to 20 hours D. Onset of 6 to 14 hours from injection time, peak of 10 to 16 hours later, and duration time of 20 to 24 hours
B. Onset of 30 minutes from injection time, peak of 2 to 4 hours later, and duration time of 4 to 8 hours Regular insulin has an onset of action of 30 minutes from injection time, peak action of 2 to 4 hours later, and a duration time of 4 to 8 hours. Therefore, the remaining options are incorrect.
A client newly diagnosed with type 1 diabetes mellitus exercises daily. When teaching this client about medication therapy, the nurse tells the client to inject the daily dose of insulin in which location? A. In any site, but after exercise B. Only in the arm before exercise C. In a site that will not be exercised D. Only in the abdomen before exercise
C. In a site that will not be exercised Exercise of a body part increases the rate of absorption of the insulin from that site. For this reason, the client should inject insulin into an area that will not be exercised. This will help the client to avoid hypoglycemia from rapid insulin absorption.
The nurse provides information to a client diagnosed with insulin-dependent diabetes mellitus. Which manifestations resulting from a blood glucose level less than 70 mg/dL (4 mmol/L) should the nurse include in the information? Select all that apply. A. Hunger B. Sweating C. Weakness D. Nervousness E. Cool clammy skin F. Increased urinary output
A, B, C, D, E Hypoglycemia is characterized by a blood glucose level less than 70 mg/dL (4 mmol/L). Clinical manifestations of hypoglycemia include hunger, sweating, weakness, nervousness, cool clammy skin, blurred vision or double vision, tachycardia, and palpitations. Increased urinary output is a manifestation of hyperglycemia.
The home care nurse visits a client diagnosed with type 1 diabetes mellitus who takes NPH insulin every morning and checks the client's blood glucose level 4 times per day. The client tells the nurse that, yesterday, the late afternoon blood glucose was 60 mg/dL (3.42 mmol/L) and that she "felt funny." Which statement by the client indicates an understanding of this occurrence? A. "I forgot to take my usual afternoon snack yesterday." B. "My blood glucoses are running low because I'm tired." C. "I took less insulin this morning, so I won't feel funny today." D. "I think I 'felt funny' because my insulin was close to expiring."
A. "I forgot to take my usual afternoon snack yesterday." Hypoglycemia is a blood glucose level of 60 mg/dL (3.42 mmol/L) or less. The causes are multiple, but in this case, omitting the afternoon snack is the cause. Fatigue and self-adjustment of dose are incorrect options. The medication had not yet expired and so was safe to administer.
A client diagnosed with diabetes mellitus receives 8 units of regular insulin subcutaneously at 7:30 am. The nurse should be most alert to signs of hypoglycemia at what time during the day? A. 9:30 am to 11:30 am B. 11:30 am to 1:30 pm C. 1:30 pm to 3:30 pm D. 3:30 pm to 5:30 pm
A. 9:30 am to 11:30 am Regular insulin is a short-acting insulin. Its onset of action occurs in a half hour and peaks in 2 to 4 hours. Its duration of action is 4 to 6 hours. A hypoglycemic reaction will most likely occur at peak time, which in this situation is between 9:30 am and 11:30 am.
The nurse is teaching the client about insulin glargine. Which client statement indicates that the client has correct understanding of the medication? A. "This medication can be added to my insulin pump." B. "I plan to take this medication 30 minutes before each meal." C. "I will administer this medication once each night before bed." D. "I'll monitor my blood glucose levels at least every other day."
C. "I will administer this medication once each night before bed." Insulin glargine is a modified human insulin with a prolonged duration of action (at least 24 hours). The medication is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes mellitus and adults with type 2 diabetes mellitus. According to package labeling, the daily injection should be made at bedtime. Regular insulin is the only insulin that can be added to an insulin pump. Regardless of the type of insulin the client uses, the blood glucose should be monitored at least daily if not more often.
The nurse monitors the client for a hypoglycemic reaction, knowing that NPH insulin peaks in approximately how many hours following administration? A. 1 hour B. 2 to 3 hours C. 8 to 12 hours D. 16 to 24 hours
C. 8 to 12 hours other options give either times that are too long or too short
The nurse is teaching a client how to mix regular and NPH insulins in the same syringe. Which action should the nurse instruct the client to take? A. Draw up the NPH insulin into the syringe first. B. Keep both bottles in the refrigerator at all times. C. Rotate the NPH insulin bottle in the hands before mixing. D. Take all of the air out of the insulin bottles before mixing
C. Rotate the NPH insulin bottle in the hands before mixing. the NPH insulin bottle needs to be rotated for at least 1 minute between both hands. This resuspends the insulin. The nurse should not shake the bottles. Shaking causes foaming and bubbles to form, which may trap particles of insulin and alter the dosage. Regular insulin is drawn up before NPH insulin. Insulin may be maintained at room temperature. Additional bottles of insulin for future use should be stored in the refrigerator. Air does not need to be removed from the insulin bottles
The client is prescribed insulin lispro 3 times a day with the amount based on blood glucose levels. Which client statement should indicate to the nurse that the client understood discharge teaching regarding insulin lispro? A. "The medication should be administered 1 hour after each meal." B. "I should spread the 3 daily doses evenly throughout the 24-hour day." C. "Lispro should be taken at least 1 hour before each of my 3 daily meals." D. "I will take the lispro 10 to 15 minutes before I eat my daily three meals."
D. "I will take the lispro 10 to 15 minutes before I eat my daily three meals." Lispro is a rapid-acting insulin analog with an onset of action of 15 minutes. The client should administer the dose 10 to 15 minutes before eating a meal. Because the drug peaks in ¾ to 1½ hours, it would not be beneficial to wait for 1 hour after the meal to administer it. In addition, if the lispro is given 1 hour before the meal, the medication will begin to peak before the client's meal is eaten. Lispro administration should not be spread out through equal time intervals.
The client's health care provider has prescribed regular insulin 10 units and NPH insulin 20 units subcutaneously every morning. Which nursing action regarding administration of insulin is correct? A. Shake the NPH insulin vial to distribute the suspension. B. Administer each type of insulin using separate syringes. C. Administer both the regular insulin and the NPH insulin at 12:00 noon D. Draw up the regular insulin first, and then the NPH insulin in the same syringe.
D. Draw up the regular insulin first, and then the NPH insulin in the same syringe. Regular insulin and NPH insulin can be mixed together in the same syringe for administration. Regular insulin is drawn up before the NPH insulin. Insulin is usually administered 15 to 30 minutes before a meal. To mix the NPH insulin suspension, the vial should be gently rotated. Shaking should be avoided because doing so introduces air bubbles into the solution.
