Pharmacology Diabetes meds #2

Question

Which action is priority for the nurse to do before administering 9 units of NPH insulin and 4 units of regular insulin that is scheduled for 11:30 am?

Answers

  1. Shake the NPH insulin
    • Rationale:

      This answer is not correct because, although shaking the NPH insulin should be performed before administration of the insulin, it is not the priority before checking the blood glucose. NPH is a suspension and should be shaken before insulin is removed from the vial.

  2. Place air into the NPH insulin
    • Rationale:

      This answer is not correct because, although placing air in the NPH insulin vial should occur before placing air in the regular insulin is the appropriate order before removing the insulin, it is not the priority before checking the blood glucose. Regular insulin should be pulled up in the syringe before NPH, so placing air in the NPH insulin vial first, then placing air in the regular insulin so it can be pulled up first, is the proper order.

  3. Perform a bedside blood glucose check
    • Rationale:

      This answer is correct because the patient’s blood glucose should be checked before all the other answers. This is safe nursing practice. The patient’s blood glucose should be checked to be sure it is high enough to deliver a safe dosage of insulin. Otherwise, deadly consequences could occur.

  4. Check the expiration date of both insulins
    • Rationale:

      This answer is not correct because, although it is correct and appropriate to check the expiration date on an insulin vial, it is not the priority before checking the blood glucose. The insulin expiration vial is only valid if the insulin is refrigerated, otherwise, the insulin should only be kept 28 days outside the refrigerator.

Overview

Performance and assessment of a blood glucose check is priority before administration of any insulin. This is safe nursing practice and should be done regardless of the circumstance.

Explanation

Learning Outcomes

Blood glucose levels must be assessed before administration of any type of insulin. This is an absolute for the safety of the patient. If a patient’s blood glucose was unknowingly too low, administration of insulin could cause severe hypoglycemia, coma, and potentially, death. Bedside glucose is more easily and readily available for preadministration times. If there is a doubt, venous blood can be obtained. Regardless of the method, obtaining an accurate blood glucose level is priority before the patient is ever given, or gives themselves insulin.

Test Taking Tip

Remember, when a question asks for what the nurse should do “first” or what the priority action is, all answers are appropriate to do, but only one is the priority or should be done first. Something detrimental could occur if that step is not completed first.

Video Rationale