The insulin that has the most rapid onset of action would be:
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Solution
Lispro
Lispro has an immediate onset, a peak of 30-90 minutes, and duration of 2-4 hours.
The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order.
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Solution
Answer: 1, 3, 2, 4.
A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:
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Solution
Administer the insulin as ordered
A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.
The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:
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Solution
Increases blood glucose levels
Glucagon, an insulin antagonist produced by the alpha cells in the islets of Langerhans, leads to the conversion of glycogen to glucose in the liver.
A client’s blood gases reflect diabetic acidosis. The nurse should expect:
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Solution
Decreased HCO3
The bicarbonate-carbonic acid buffer system helps maintain the pH of the body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids.
Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply:
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Solution
Answer: 2, 3.
Metabolic acidosis initiates respiratory compensation in the form of Kussmaul’s respirations to counteract the effects of ketone buildup, resulting in a lowered PCO2. A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis.
The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:
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Solution
“The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”
The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected.
When a client is in diabetic ketoacidosis, the insulin that would be administered is:
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Solution
Human regular insulin
Regular insulin (Humulin R) is a short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes <13.9 mmol/L (<250 mg/dL). At this point, insulin dose should be decreased by half, to 0.1 units/kg every 2 hours, until the resolution of DKA.
The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.
1. Thirst
2. Palpitations
3. Diaphoresis
4. Slurred speech
5. Hyperventilation
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Solution
Answer: 2, 3, 4.
Palpitations, an adrenergic symptom, occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.
When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide:
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Solution
Fluid replacement
As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.