Podcast
Questions and Answers
A nurse is preparing to administer insulin to a client with diabetes mellitus. Which of the following actions is most crucial to ensure client safety during this procedure?
A nurse is preparing to administer insulin to a client with diabetes mellitus. Which of the following actions is most crucial to ensure client safety during this procedure?
- Mixing different types of insulin in the same syringe to reduce the number of injections.
- Administering the insulin at a consistent anatomical site to promote predictable absorption.
- Confirming the client's identity using two unique identifiers and verifying allergy status. (correct)
- Warming the insulin vial to body temperature before drawing up the dose.
The registered nurse (RN) is delegating tasks to a practical nurse (PN) and an assistive personnel (AP). Which task related to insulin administration is appropriate to delegate to the PN?
The registered nurse (RN) is delegating tasks to a practical nurse (PN) and an assistive personnel (AP). Which task related to insulin administration is appropriate to delegate to the PN?
- Monitoring the client for signs and symptoms of hypoglycemia after insulin administration.
- Drawing up and administering the prescribed dose of insulin to a stable client. (correct)
- Assessing the client's understanding of their insulin regimen and potential side effects.
- Educating the client and family about proper insulin storage and injection techniques.
A nurse is preparing an insulin injection and notes air bubbles in the syringe. What is the most appropriate nursing action to address this situation?
A nurse is preparing an insulin injection and notes air bubbles in the syringe. What is the most appropriate nursing action to address this situation?
- Disregard the air bubbles if they are small, as they will be absorbed by the body.
- Firmly tap the syringe barrel to move the air bubbles to the top, then expel the air. (correct)
- Inject the air bubbles into the subcutaneous tissue, as they will not cause harm.
- Expel a small amount of insulin into the vial to compensate for the air bubbles.
A nurse is administering insulin to a client and is unsure about which injection site to use. What is the most appropriate action for the nurse to take?
A nurse is administering insulin to a client and is unsure about which injection site to use. What is the most appropriate action for the nurse to take?
After administering an insulin injection, the nurse observes blood at the injection site. What is the most appropriate initial nursing action?
After administering an insulin injection, the nurse observes blood at the injection site. What is the most appropriate initial nursing action?
Which of the following actions is most important for the nurse to take immediately after administering an insulin injection?
Which of the following actions is most important for the nurse to take immediately after administering an insulin injection?
A nurse is teaching a client about insulin self-administration. Which statement by the client indicates a need for further education?
A nurse is teaching a client about insulin self-administration. Which statement by the client indicates a need for further education?
A client receiving insulin reports sweating, shaking, and confusion. What is the nurse's priority action?
A client receiving insulin reports sweating, shaking, and confusion. What is the nurse's priority action?
A nurse is preparing to administer insulin from a multi-dose vial. What is the most important step to ensure the medication's continued efficacy?
A nurse is preparing to administer insulin from a multi-dose vial. What is the most important step to ensure the medication's continued efficacy?
A nurse is reviewing a client's medication administration record (MAR) before administering insulin. Which of the following elements is most critical to verify?
A nurse is reviewing a client's medication administration record (MAR) before administering insulin. Which of the following elements is most critical to verify?
A nurse is preparing to administer insulin to a client. Prior to administering the medication, what assessment finding would warrant withholding the insulin and contacting the provider?
A nurse is preparing to administer insulin to a client. Prior to administering the medication, what assessment finding would warrant withholding the insulin and contacting the provider?
A nurse is providing education to a client newly diagnosed with diabetes mellitus who will be self-administering insulin. Which of the following statements by the client indicates an understanding of proper injection technique?
A nurse is providing education to a client newly diagnosed with diabetes mellitus who will be self-administering insulin. Which of the following statements by the client indicates an understanding of proper injection technique?
A nurse is preparing to administer insulin to a client and notes that the client received an oral hypoglycemic medication earlier in the day. What is the most appropriate nursing action?
A nurse is preparing to administer insulin to a client and notes that the client received an oral hypoglycemic medication earlier in the day. What is the most appropriate nursing action?
A nurse is caring for a client who is receiving insulin therapy. Which of the following findings should the nurse recognize as an indication that the client is experiencing hyperglycemia?
A nurse is caring for a client who is receiving insulin therapy. Which of the following findings should the nurse recognize as an indication that the client is experiencing hyperglycemia?
A nurse is preparing to administer insulin to a client. The nurse notes that the client’s abdomen has multiple areas of lipohypertrophy. Which action is most appropriate?
A nurse is preparing to administer insulin to a client. The nurse notes that the client’s abdomen has multiple areas of lipohypertrophy. Which action is most appropriate?
A nurse is preparing to administer insulin to a client. The nurse draws up the insulin, then is called away to assist with an emergency in another room. What action should the nurse take?
A nurse is preparing to administer insulin to a client. The nurse draws up the insulin, then is called away to assist with an emergency in another room. What action should the nurse take?
A nurse is administering insulin to an older adult client with decreased subcutaneous tissue. At what angle should the nurse administer the injection?
A nurse is administering insulin to an older adult client with decreased subcutaneous tissue. At what angle should the nurse administer the injection?
A nurse is teaching a client about the proper storage of insulin. Which of the following statements indicates that the client understands the instructions?
A nurse is teaching a client about the proper storage of insulin. Which of the following statements indicates that the client understands the instructions?
Prior to administering insulin, the nurse reviews the client's orders and notes the prescription reads: 'Administer 10 units of insulin lispro AC.' What does 'AC' indicate in this order?
Prior to administering insulin, the nurse reviews the client's orders and notes the prescription reads: 'Administer 10 units of insulin lispro AC.' What does 'AC' indicate in this order?
A nurse is caring for a client with diabetes mellitus who is scheduled to receive insulin. The nurse understands that which laboratory value is most important to review before administering the insulin?
A nurse is caring for a client with diabetes mellitus who is scheduled to receive insulin. The nurse understands that which laboratory value is most important to review before administering the insulin?
A nurse is preparing to administer insulin to a client who is at risk for hypoglycemia. Which of the following actions should the nurse perform first?
A nurse is preparing to administer insulin to a client who is at risk for hypoglycemia. Which of the following actions should the nurse perform first?
A nurse is administering insulin to a client with a known allergy to alcohol. Which action is most appropriate?
A nurse is administering insulin to a client with a known allergy to alcohol. Which action is most appropriate?
A nurse is providing discharge instructions to a client who will be self-administering insulin at home. Which of the following instructions is most important to include?
A nurse is providing discharge instructions to a client who will be self-administering insulin at home. Which of the following instructions is most important to include?
A nurse is preparing to administer insulin to a client and notes that the insulin vial is cloudy. What action should the nurse take?
A nurse is preparing to administer insulin to a client and notes that the insulin vial is cloudy. What action should the nurse take?
A nurse is administering insulin to a client who is NPO (nothing by mouth) due to a scheduled surgical procedure. What is the most appropriate action?
A nurse is administering insulin to a client who is NPO (nothing by mouth) due to a scheduled surgical procedure. What is the most appropriate action?
A nurse is preparing to administer insulin to a client. The nurse notices that the date on the multi-dose vial of insulin indicates that it expired 1 week ago. What action should the nurse take?
A nurse is preparing to administer insulin to a client. The nurse notices that the date on the multi-dose vial of insulin indicates that it expired 1 week ago. What action should the nurse take?
A nurse is delegating the task of blood glucose monitoring to assistive personnel (AP). Which instruction is most important for the nurse to provide to the AP?
A nurse is delegating the task of blood glucose monitoring to assistive personnel (AP). Which instruction is most important for the nurse to provide to the AP?
A nurse is preparing to administer insulin to a client who also takes warfarin. The nurse should monitor the client closely for which potential interaction?
A nurse is preparing to administer insulin to a client who also takes warfarin. The nurse should monitor the client closely for which potential interaction?
A nurse is teaching a client about the Somogyi effect. Which statement by the nurse best describes this phenomenon?
A nurse is teaching a client about the Somogyi effect. Which statement by the nurse best describes this phenomenon?
A nurse is caring for a client who is receiving both regular insulin and NPH insulin. Which procedure is correct when drawing up these two insulins into one syringe?
A nurse is caring for a client who is receiving both regular insulin and NPH insulin. Which procedure is correct when drawing up these two insulins into one syringe?
A nurse is teaching a client how to administer insulin using an insulin pen. Which of the following instructions should the nurse include?
A nurse is teaching a client how to administer insulin using an insulin pen. Which of the following instructions should the nurse include?
A nurse is evaluating a client's understanding of sick day management for diabetes. Which statement indicates a need for further education?
A nurse is evaluating a client's understanding of sick day management for diabetes. Which statement indicates a need for further education?
A nurse is caring for a pregnant client with gestational diabetes who requires insulin. Which consideration is most important when administering insulin to this client?
A nurse is caring for a pregnant client with gestational diabetes who requires insulin. Which consideration is most important when administering insulin to this client?
A nurse is caring for a client who has been prescribed pramlintide in addition to insulin. The nurse recognizes that which statement about pramlintide is correct?
A nurse is caring for a client who has been prescribed pramlintide in addition to insulin. The nurse recognizes that which statement about pramlintide is correct?
A nurse is preparing to administer insulin to a client. After drawing up the insulin, the nurse is called away to assist with a critical situation. What is the most appropriate action?
A nurse is preparing to administer insulin to a client. After drawing up the insulin, the nurse is called away to assist with a critical situation. What is the most appropriate action?
The nurse is teaching a client about insulin self-administration and the importance of rotating injection sites. Which statement indicates the client needs further instruction?
The nurse is teaching a client about insulin self-administration and the importance of rotating injection sites. Which statement indicates the client needs further instruction?
A nurse is administering insulin to a client who is also receiving an anticoagulant. Which of the following nursing actions is most important to implement?
A nurse is administering insulin to a client who is also receiving an anticoagulant. Which of the following nursing actions is most important to implement?
A nurse is preparing to administer insulin to a client with fluctuating blood glucose levels. Which type of insulin administration approach would allow for the most flexibility and control over blood glucose levels based on the client’s current needs?
A nurse is preparing to administer insulin to a client with fluctuating blood glucose levels. Which type of insulin administration approach would allow for the most flexibility and control over blood glucose levels based on the client’s current needs?
A nurse is caring for a client with diabetes who is prescribed both insulin glargine and insulin lispro. How should the nurse administer these medications?
A nurse is caring for a client with diabetes who is prescribed both insulin glargine and insulin lispro. How should the nurse administer these medications?
A client who has been managing their diabetes well at home is admitted to the hospital for an unrelated surgical procedure. The provider prescribes the client's usual insulin regimen. What is the nurse’s priority action?
A client who has been managing their diabetes well at home is admitted to the hospital for an unrelated surgical procedure. The provider prescribes the client's usual insulin regimen. What is the nurse’s priority action?
A nurse is providing discharge instructions to a client newly diagnosed with diabetes who will be self-administering insulin. Which statement by the client indicates an unsafe understanding of insulin administration?
A nurse is providing discharge instructions to a client newly diagnosed with diabetes who will be self-administering insulin. Which statement by the client indicates an unsafe understanding of insulin administration?
A nurse is preparing to administer insulin to a client and notes the insulin vial has been left at room temperature for several weeks. What is the most important action?
A nurse is preparing to administer insulin to a client and notes the insulin vial has been left at room temperature for several weeks. What is the most important action?
A nurse is teaching a client with diabetes about the use of an insulin pen. Which instruction about priming the pen before each injection is most important?
A nurse is teaching a client with diabetes about the use of an insulin pen. Which instruction about priming the pen before each injection is most important?
A nurse is preparing to administer insulin to a client and notes that the client's blood glucose level is 50 mg/dL. Which action is the most appropriate?
A nurse is preparing to administer insulin to a client and notes that the client's blood glucose level is 50 mg/dL. Which action is the most appropriate?
Flashcards
Insulin administration delegation
Insulin administration delegation
RNs can delegate insulin administration to PNs, but not to AP, as it is outside their scope of practice.
Rights of Medication Administration
Rights of Medication Administration
Ensuring correct medication, dose, route, time and client is crucial in medication administration.
Pre-Administration Review
Pre-Administration Review
Review client's allergies, medical history, medications, labs and provider's orders.
Client Education
Client Education
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Hypoglycemia Symptoms
Hypoglycemia Symptoms
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Injection Site Rotation
Injection Site Rotation
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Injecting air into insulin vial
Injecting air into insulin vial
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Removing Air Bubbles
Removing Air Bubbles
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Double Check Insulin Doses
Double Check Insulin Doses
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One-Handed Scoop Method
One-Handed Scoop Method
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Cleaning Injection Site
Cleaning Injection Site
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45° Angle for Injection
45° Angle for Injection
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Post-Injection Care
Post-Injection Care
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Post-Administration Evaluation
Post-Administration Evaluation
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Hypoglycemia Intervention
Hypoglycemia Intervention
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Medication Documentation
Medication Documentation
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Study Notes
- Clients with diabetes mellitus (DM) often require insulin injections to lower blood glucose levels, administered into subcutaneous tissue.
- RNs can delegate insulin administration to PNs, but not to assistive personnel (AP) due to scope of practice.
- Following medication administration protocols is essential for client safety and error prevention.
Skills and Nursing Process
- Skills performance guidance aligns with best practices, with each step linked to a nursing process phase.
- Due to the nursing process being dynamic, steps may shift between phases.
Safety Considerations
- Check for allergies to prevent allergic reactions.
- Verify client identification to ensure correct procedure on the right client, according to facility protocol.
- Utilize standard precautions to prevent infection transmission, with additional measures based on medical history and protocols.
- Adhere to medication administration rights: client, medication, dose, route, time, documentation, assessment, evaluation, refusal, and education.
Equipment
- Needed: Nonsterile gloves/PPE, MAR, antiseptic, insulin syringe/needle, and insulin vial.
- MAR provides information on insulin type, dose, and timing.
- Insulin syringes are used for accurate dosing.
General Steps Prior to Medication Administration
- Review the client’s medical record.
- Assess allergies, medical history, medications, vital signs, labs, and the provider's prescription.
- Review facility policy for the skill to identify contraindications and validate the prescription.
- Obtain necessary supplies and confirm they are clean.
- Providing privacy maintains client confidentiality.
- Introduce yourself to build a therapeutic relationship.
- Perform hand hygiene and wear PPE to prevent infection.
- Verify client identity using two identifiers.
- Confirm the client’s allergy status.
- Educate the client about the medication, potential adverse effects, administration procedure, and right to refuse.
- Follow medication administration rights; minimize distraction.
- Check the MAR, provider prescription, need, interactions, contraindications, dosing, and considerations.
- Check MAR, remove medication, compare label, and check expiration.
- Calculate dosage if needed.
- Interruptions during medication prep increases errors.
At the Client’s Bedside
- Gather supplies and take medication at the correct time.
- Perform hand hygiene and wear PPE.
- Verify the client’s identity and scan the ID bracelet per facility policy.
- Recheck medication label against MAR and scan the medication barcode.
- Check pertinent findings immediately prior to administration.
- Assess for hypoglycemia (sweating, shaking, clammy skin, lethargy, confusion, dizziness, nausea).
- Assess for hyperglycemia (increased thirst/urination).
- Review MAR for recent injection sites before selecting a new one.
- Clean the insulin vial top with an antimicrobial wipe, allowing it to dry.
- Remove the syringe cap and draw air equal to the prescribed dose.
- Inject air into the vial while holding it on a flat surface.
- Invert the vial and syringe, keeping the needle tip below fluid level.
- Draw the prescribed amount of insulin, keeping the vial and syringe at eye level.
- Remove air bubbles by tapping the syringe and injecting air back into the vial.
- Carefully remove the needle and recap using the one-hand scoop method.
- Verify medication dose with another nurse per facility policy, especially for high-alert medications like insulin.
- Label multidose vial with date/time opened, if applicable.
- Store multidose vial per facility policy.
- Raise the bed, position the client, and maintain privacy.
- Assess skin integrity at the site, cleanse with antiseptic, and let it dry.
- Remove the syringe cap.
- Pinch skin at the injection site if needed.
- Inject the needle at a 45° to 90° angle, depending on tissue thickness.
- Stabilize the syringe and inject insulin slowly.
- Wait 5 seconds, then withdraw the needle at the same angle.
- Engage safety shield and discard in sharps container.
- Apply gentle pressure if needed, but do not massage the site.
- Assist the client to a comfortable position.
- Ensure client safety before leaving the room.
Methods for Reducing Fall Risk
- Call light and items within reach.
- Lower the bed to the lowest position with brakes locked.
- Evaluate medication outcome at the appropriate time frame.
Client Considerations
- Inject at a 45° angle for thin adults and most children.
Interventions for Unexpected Outcomes
- Check blood glucose and follow facility guidelines for hypoglycemia interventions.
Documentation
- Document date/time, nurse's initials/signature, medication, dose, route, pertinent findings, education, and client's response and unexpected outcomes.
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