After a blood glucose reading, it is determined that the patient ...

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After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications?
 
  a. Draw up each insulin in separate syringes and administer two injections.
  b. Draw up the NPH first and then the Lispro using the same syringe.
  c. Administer the Lispro before the meal and the NPH after the meal.
  d. Draw up the Lispro first and then the NPH using the same syringe.

Question 2

It is 2:00 PM and a patient who has been NPO since 12:00 AM for a bronchoscopy is complaining of a headache and shakiness and is extremely irritable. Vital signs are within normal limits, and a one touch glucose reads 50 mg/dL.
 
  Which action is most important for the nurse to take?
  a. Have the patient eat a snack and drink milk.
  b. Administer glucagon subcutaneously.
  c. Call the bronchoscopy room to follow up with the delay.
  d. Obtain an A1c test.

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Answer to Question 1

ANS: D
Lispro, an insulin analogue, is the most rapid-acting insulin. Insulin analogues are compatible with intermediate (NPH) or long-acting insulin. When combining two types of insulin, the short-acting insulin is drawn up before the intermediate-acting insulin. There is no reason to administer a second injection. The long-acting insulin is drawn up last when mixing. Insulin is to be administered before meals.

Answer to Question 2

ANS: B
Irritability, nervousness, headache, tremors, dizziness, apprehension, sweating, cold and clammy skin, and hunger are symptoms of hypoglycemia. The patient has not eaten since the prior day. A blood glucose of 50 mg/dL is true hypoglycemia and needs to be dealt with immediately. Glucagon is preferred over PO intake, given that an endoscopy is scheduled. Having the patient eat a snack and drink milk, calling the bronchoscopy room, and obtaining an A1c test are not appropriate responses.

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