QMA Insulin Sliding Scale Insulin 2 — Questions and Answers
Question 1: A resident's blood glucose is 210 mg/dL. The sliding scale orders: 151-200 = 2 units, 201-250 = 4 units, 251-300 = 6 units. How many units should be given?
- 2 units
- 4 units (Correct answer)
- 6 units
- 0 units
Correct answer: 4 units
210 mg/dL falls in the 201-250 range, so 4 units of insulin is the correct dose.
Question 2: When administering sliding scale insulin, which type of insulin is most commonly used?
- NPH (intermediate-acting)
- Glargine (long-acting)
- Regular or rapid-acting insulin (Correct answer)
- Premixed 70/30 insulin
Correct answer: Regular or rapid-acting insulin
Sliding scale regimens use regular or rapid-acting insulin because they work quickly to correct elevated blood glucose.
Question 3: A QMA checks a resident's blood glucose before a meal and gets a reading of 58 mg/dL. The sliding scale starts at 150 mg/dL. What is the FIRST action?
- Administer the lowest dose on the scale
- Skip the insulin and notify the nurse immediately (Correct answer)
- Wait 30 minutes and recheck
- Document and proceed with the meal only
Correct answer: Skip the insulin and notify the nurse immediately
A blood glucose of 58 mg/dL is hypoglycemic; no insulin should be given and the nurse must be notified immediately.
Question 4: Which documentation must be completed IMMEDIATELY after administering sliding scale insulin?
- Only the blood glucose reading
- Blood glucose value, dose given, site used, time, and initials (Correct answer)
- The resident's weight and vital signs
- A nursing progress note only
Correct answer: Blood glucose value, dose given, site used, time, and initials
Complete documentation requires the blood glucose reading, insulin dose, injection site, time of administration, and the QMA's initials.
Question 5: A sliding scale order reads 'hold insulin and call nurse if glucose > 400 mg/dL.' A resident's glucose is 425 mg/dL. What should the QMA do?
- Give the highest dose on the scale
- Give 2 extra units beyond the highest scale dose
- Hold insulin and notify the nurse (Correct answer)
- Recheck glucose in 15 minutes before calling
Correct answer: Hold insulin and notify the nurse
When glucose exceeds the upper limit with a 'hold and call' instruction, the QMA must withhold insulin and contact the nurse immediately.
Question 6: At what angle is a subcutaneous insulin injection typically administered to a thin or average adult?
- 90 degrees
- 45 degrees
- 15 degrees
- Either 45 or 90 degrees depending on tissue depth (Correct answer)
Correct answer: Either 45 or 90 degrees depending on tissue depth
Injection angle depends on the amount of subcutaneous tissue; 90° is used with adequate tissue and short needles, 45° for thinner individuals.
Question 7: A resident refused breakfast but a sliding scale insulin dose was already drawn up. What should the QMA do?
- Administer the insulin anyway to prevent hyperglycemia
- Discard the drawn dose and notify the nurse (Correct answer)
- Store the drawn dose in the refrigerator for later
- Give half the dose and document the refusal
Correct answer: Discard the drawn dose and notify the nurse
A pre-drawn dose that cannot be administered must be discarded per facility policy, and the nurse must be notified about the meal refusal.
QMA Insulin Sliding Scale Insulin 2
A resident's blood glucose is 210 mg/dL.
The sliding scale orders: 151-200 = 2 units, 201-250 = 4 units, 251-300 = 6 units.
How many units should be given?