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Test Bank for The Nurse The Math The Meds 3rd
Edition by Mulholland
ESSAY
1. a. What are the three main classifications of insulin activity (onset and/or duration)?
b. Does insulin elevate or lower blood glucose levels?
ANS:
ANS:
a.
b. Rapid
c. 100 units per mL
ANS:
a. 100 units per mL
b.
c. Long-acting
d. Insulin glargine does not have a peak. It can be given any time of day as long as it is the
same time each day.
ANS:
a.
b. Rapid
c. Patients with impaired vision benefit from using this syringe. Doses can be read more
easily.
5. Ordered: an insulin mix—Humulin R 4 units, subcut AM and PM; Humulin N 26 units, 30
minutes before meals
a. Is Humulin N a rapid-, intermediate-, or long-acting insulin?
b. Which type of insulin should the nurse withdraw first for the mix: Humulin R or
Humulin N? State the reason for this decision.
c. Mark the total dose. Indicate the Humulin R and Humulin N doses with arrows.
ANS:
a. Intermediate
b. The short/rapid acting Humulin R must be withdrawn first to protect it from
contamination with a longer acting insulin. Contamination could change the action of the
regular insulin.
c. First arrow shows 4 units drawn to Humulin R, total dose shown with second arrow at 30
units when Humulin N dose is added.
6. Ordered: Novolin R subcut per sliding scale q6h, for a patient receiving total parenteral
nutrition
Blood Glucose (mg per Insulin (units)
dL)
70-150 0
151-200 4
201-250 6
251-300 10
a. The patient’s blood glucose level is 240 mg per dL. How many units should the nurse
administer?
b. Why must U be written out as units in medical records?
ANS:
a. 6 units
b. U can be misread as 0 (zero)
ANS:
ANS:
a. Estimate: The concentration is or 2 mL for each unit; therefore, the flow rate
estimate is 8 mL per hour.
b.
c. Equation is balanced. Estimate supports answer. Only mL per hour remain.
d. Regular insulin products and insulin lispro (Humalog) may be administered
intravenously. Intermediate, long-acting, mixed insulins, and insulin aspart (NovaLog)
cannot be administered intravenously due to additives.
ANS:
10. a. What two products must be on hand for IV administration for a severe hypoglycemic
reaction?
b. What kinds of insulins require a bedtime snack unless otherwise ordered?
c. State the reason.
ANS:
ANS:
DM type 1 and DM type 2
12. If a patient is to receive a premixed insulin as noted on the label below, which number
indicates the intermediate-acting insulin percentage?
ANS:
The first number refers to the intermediate acting insulin.
13. If a patient’s blood glucose level is 295, which insulin infusion rate would you administer
according the sliding scale below?
Blood Glucose Level (mg per dL) Infusion Rate (units per hr)
151-200 1
201-250 2
251-300 3
301-400 4
Over 400 5 and call MD
ANS:
3 units per hr
ANS:
70 to 100 mg per dL. The preferred norm varies among physicians. A result in the low 80 mg
per dL is preferred by some physicians. Fasting means only water for 8 hours before the test.
Caffeine and other products will raise the fasting blood sugar.
ANS:
hypoglycemia
16. Name the route that is most commonly prescribed for patients to self-administer insulin.
ANS:
subcut
17. What is the name of the hormone that may be administered by injection for severe
hypoglycemic levels?
ANS:
glucagon
ANS:
SMBG refers to fingerstick self-monitoring, reported by patient. BGM refers to fingerstick
report, usually done by nurse.
19. If a patient receives insulin and doesn’t eat, what happens to the blood glucose level?
ANS:
Blood glucose level drops; hypoglycemia occurs.
20. If the patient doesn’t take the prescribed antidiabetic medicine, what happens to the blood
glucose level?
ANS:
Blood glucose level rises; hyperglycemia occurs.
21. What is the most commonly ordered insulin concentration per mL?
ANS:
100 U per mL
22. When giving insulin injections subcutaneously, what area on the abdomen must be avoided
and by how many inches of radius?
ANS:
Umbilicus should be avoided by radius of 2 inches.
ANS:
A current blood glucose level
24. What serious ADE could the nurse expect if the dose prepared for an order of 4 units of
Regular insulin and 26 units of intermediate acting insulin was reversed?
ANS:
The patient would rapidly become hypoglycemic and have high probability of insulin shock.
25. Which specific part of the following sliding scale would necessitate clarification with the
prescriber?
Blood Glucose Level (mg per dL) Regular Insulin (units subcut)
0-180 0 units
180-250 2 units
251-300 4 units
300-350 6 units
Over 350 8 units and call MD
ANS:
The 180 level is indicated for two of the orders: 0 and 2 units.
26. Can long-acting insulins be given IV? If so, why; if not, why not?
ANS:
Long-acting insulins cannot be given IV. They contain additives to extend the action.
27. Why are bedtime snacks such as half of a sandwich or milk ordered for patients on
intermediate and long-acting or evening insulin?
ANS:
Intermediate, evening, and long-acting insulins lower blood sugar during the night. To avoid
hypoglycemic episodes during sleep, or during the night, a balanced small snack is given.
MULTIPLE CHOICE
1. A test that determines the average blood glucose level over the past 2 to 3 months is called:
a. HbA1c (glycosolated hemoglobin)
b. Fasting blood glucose (FBS)
c. Postprandial glucose test
d. BGM
Test Bank for The Nurse The Math The Meds 3rd Edition by Mulholland
ANS: A
3. If a patient is having a hypoglycemic episode, which of the following choices would be best to
give first if the patient is able to swallow?
a. Diet cola
b. Coffee (caffeine)
c. Orange juice
d. An antidiabetic pill
ANS: C