Free LPN Diabetes Care: Glucose and Insulin Questions and Answers — Questions and Answers
Question 1: An LPN is preparing to administer a mixture of regular insulin and NPH insulin. What is the correct procedure for drawing up the insulins?
- Draw up the NPH insulin, then the regular insulin in the same syringe.
- Draw up the regular insulin, then the NPH insulin in the same syringe. (Correct answer)
- Use two separate syringes for the injections.
- Draw up the NPH insulin, clear the air bubbles, then add the regular insulin.
Correct answer: Draw up the regular insulin, then the NPH insulin in the same syringe.
When mixing insulins, the clear (short-acting, like Regular) insulin should be drawn up before the cloudy (intermediate-acting, like NPH) insulin. This prevents contaminating the short-acting insulin vial with the intermediate-acting insulin. The mnemonic 'clear before cloudy' is helpful.
Question 2: A client with type 1 diabetes reports feeling shaky, dizzy, and diaphoretic. The LPN checks the client's blood glucose, which is 58 mg/dL. The client is conscious and able to swallow. What is the LPN's priority action?
- Administer the client's scheduled dose of long-acting insulin.
- Provide the client with 4 oz of orange juice. (Correct answer)
- Give the client a protein bar and a glass of milk.
- Notify the registered nurse (RN) immediately without taking action.
Correct answer: Provide the client with 4 oz of orange juice.
The client is experiencing hypoglycemia. The priority for a conscious client is to provide a fast-acting carbohydrate to raise blood glucose levels quickly. The 'rule of 15' suggests giving 15 grams of a simple carbohydrate, such as 4 oz (120 mL) of juice or regular soda, and rechecking blood glucose in 15 minutes.
Question 3: When reinforcing teaching about insulin injection site rotation, what is the best instruction for the LPN to provide?
- Use the same injection spot for every dose.
- Alternate between the right and left arm for each injection.
- Rotate sites within one area before moving to a new area. (Correct answer)
- Only use the abdomen for insulin injections.
Correct answer: Rotate sites within one area before moving to a new area.
To ensure consistent insulin absorption and prevent lipodystrophy (changes in subcutaneous fat), clients should rotate injection sites within one anatomical area (e.g., the abdomen) for about a week before moving to a new area (e.g., the thigh). Using the same exact spot repeatedly can cause tissue damage.
Question 4: A client is prescribed rapid-acting insulin (lispro) on a sliding scale to be administered before meals. The LPN should administer the insulin at what time?
- 30 to 60 minutes before the meal
- At the same time each day, regardless of meals
- Immediately after finishing the meal
- No more than 15 minutes before the meal begins (Correct answer)
Correct answer: No more than 15 minutes before the meal begins
Rapid-acting insulins, like lispro, aspart, and glulisine, have a very fast onset of action (10-15 minutes). They should be administered shortly before meals (within 15 minutes) to coincide with the rise in blood glucose from food intake.
Question 5: An LPN is obtaining a capillary blood glucose sample from a client's fingertip. Which technique is correct?
- Puncture the center of the fingertip pad.
- Milk the finger vigorously before the puncture.
- Puncture the side of the fingertip. (Correct answer)
- Use the first drop of blood for the reading.
Correct answer: Puncture the side of the fingertip.
The sides of the fingertips have fewer nerve endings and are more vascular than the center pad, making the puncture less painful and yielding a better blood sample. The first drop of blood should be wiped away as it may be contaminated with tissue fluid.
Question 6: Which statement accurately describes the action of long-acting insulin, such as insulin glargine?
- It has a rapid onset and a peak action in 1-2 hours.
- It must be administered 30 minutes before each meal.
- It provides a steady level of insulin with no significant peak. (Correct answer)
- It is cloudy in appearance and must be gently rolled before use.
Correct answer: It provides a steady level of insulin with no significant peak.
Long-acting insulins (glargine, detemir) are designed to provide a steady, continuous level of insulin over a 24-hour period. They do not have a pronounced peak, which reduces the risk of hypoglycemia between meals and overnight. This mimics the basal insulin secretion of a healthy pancreas.
Question 7: A client with diabetes mellitus is being discharged. The LPN reinforces teaching about the signs of hyperglycemia. Which symptom should the client be taught to report?
- Shakiness and sweating
- Cool, clammy skin
- Increased thirst and frequent urination (Correct answer)
- Sudden confusion and headache
Correct answer: Increased thirst and frequent urination
The classic symptoms of hyperglycemia are the '3 Ps': Polydipsia (excessive thirst), Polyuria (excessive urination), and Polyphagia (excessive hunger). These occur as the body tries to get rid of excess glucose through the urine, leading to dehydration and thirst.
