Insulin Regimens And Hypoglycemia Management - NCLEX Rn

1. Which insulin type provides basal coverage with minimal or no peak (examples: glargine, detemir, degludec)?

   Long-acting insulin (basal, minimal peak). Maintains steady basal insulin levels without significant peaks to mimic natural background insulin secretion.

2. What is the standard injection route for routine outpatient insulin administration?

   Subcutaneous injection. Subcutaneous route allows for controlled absorption rates suitable for various insulin durations in daily management.

3. Which insulin is appropriate for IV infusion in emergencies such as DKA or severe hyperkalemia?

   Regular insulin (IV). Only regular insulin is stable for IV use, enabling rapid correction in acute hyperglycemia or hyperkalemia.

4. Which option is appropriate when a patient is NPO: hold prandial insulin or hold basal insulin?

   Hold prandial insulin; usually continue basal per order. Prandial covers meals, so hold when NPO; basal maintains fasting control and prevents ketosis.

5. Identify the blood glucose threshold commonly used to define hypoglycemia in adults.

   Blood glucose < $70$ mg/dL. Threshold indicates impaired counterregulation, requiring intervention to prevent symptoms and complications.

6. After giving $15$ g of carbohydrate for hypoglycemia, when should blood glucose be rechecked?

   Recheck in $15$ minutes. Allows time for carbohydrate absorption and glucose rise, guiding need for further treatment.

7. Which insulin type is used for mealtime coverage with onset about 30–60 minutes (example: regular insulin)?

   Short-acting insulin (regular). Offers mealtime coverage with a delayed onset, allowing administration 30 minutes before eating to match glucose rise.

8. Identify the best immediate action for an unconscious hypoglycemic patient without IV access.

   Administer glucagon IM or SQ. Glucagon mobilizes stored glucose, essential when unable to use oral or IV methods.

9. Identify the correct action if a patient is hypoglycemic and scheduled for rapid-acting insulin now.

   Treat hypoglycemia first; hold insulin until glucose recovers. Prioritizes resolving low glucose to avoid worsening with additional insulin administration.

10. If blood glucose remains < $70$ mg/dL after $15$ minutes, what is the next action?

    Repeat $15$ g carbohydrate and recheck in $15$ min. Follows the rule of 15 to incrementally correct persistent low glucose without overcorrection.

11. What is the immediate treatment for mild hypoglycemia in a conscious patient who can swallow?

    Give $15$ g fast-acting carbohydrate PO. Rapidly raises blood glucose via simple sugars that are quickly absorbed without digestion.

12. Which option best prevents hypoglycemia during increased physical activity for an insulin-treated patient?

    Increase carbohydrates or reduce insulin per plan. Balances increased glucose utilization during activity to maintain euglycemia.

13. What medication is used for severe hypoglycemia when there is no IV access available?

    Glucagon IM or SQ. Stimulates hepatic glycogenolysis to release glucose when oral or IV routes are unavailable.

14. Identify the correct injection site teaching to reduce lipodystrophy with repeated insulin injections.

    Rotate sites within the same anatomic area. Rotation minimizes tissue damage and ensures consistent absorption by avoiding overused sites.

15. What is the primary purpose of basal insulin in a basal–bolus regimen?

    Controls fasting and between-meal glucose. Provides continuous low-level insulin to suppress hepatic glucose production during fasting periods.

16. After glucagon is given and the patient awakens, what should be administered next to prevent recurrence?

    Oral carbohydrate plus protein/complex carb snack. Provides sustained glucose to counteract glucagon's temporary effect and prevent rebound hypoglycemia.

17. What is the preferred treatment for severe hypoglycemia when the patient cannot take oral glucose but has IV access?

    IV dextrose (e.g., D$50$W per protocol). Delivers concentrated glucose directly into bloodstream for fast reversal of severe symptoms.

18. Which insulin type is used for basal coverage with a peak (example: NPH insulin)?

    Intermediate-acting insulin (NPH). Delivers sustained basal insulin with a peak action to cover glucose needs over 12-18 hours.

19. When drawing up NPH and regular insulin in one syringe, which is drawn up first?

    Regular insulin first (clear before cloudy). Drawing clear regular insulin first prevents contamination of the vial with cloudy NPH, ensuring stability.

20. Which adrenergic symptom is a classic early sign of hypoglycemia in a conscious patient?

    Diaphoresis and tremor. Adrenergic response from catecholamine release alerts to falling glucose, prompting early intervention.

21. Which insulin type has the fastest onset and is given with meals (examples: lispro, aspart, glulisine)?

    Rapid-acting insulin. Provides quick coverage for carbohydrate intake due to onset within 15 minutes, preventing postprandial hyperglycemia.

22. What is the key nursing action to reduce hypoglycemia risk when giving rapid-acting insulin?

    Ensure meal is available and patient will eat. Timing insulin with food intake prevents unmatched insulin action leading to low blood glucose.

23. What is the primary purpose of bolus (prandial) insulin in a basal–bolus regimen?

    Controls postprandial glucose rises. Rapidly counters glucose elevation from meals by mimicking post-meal insulin release.

24. Which neuroglycopenic symptom indicates severe hypoglycemia risk (priority finding)?

    Altered mental status or confusion. Brain glucose deprivation causes cognitive impairment, signaling urgent need for glucose restoration.

25. Which insulin should not be mixed with other insulins in the same syringe (common NCLEX rule)?

    Insulin glargine (do not mix). Glargine's acidic pH causes precipitation if mixed, leading to altered pharmacokinetics and ineffective action.

Study these flashcards