INSULIN NCLEX question

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Let me begin by giving you my "run down". My school is using the Textbook "Foundations and Adult Health Nursing" by Christenson/Kockrow. Unfortunately, we were their "guinea pigs" for this new text, and ALL of our instructors are having a hard time adjusting because our curriculum was written to match a different text, and the textbooks that we got are very difficult to navigate because of a lot of flipflops in the information and a great deal of typos. I am not saying that the text is good, it is just not the best out there. Which brings me to my question,

We are rounding out the "endocrine" system with the subject matter of INSULIN. Types/Dosages/To-dos?Not-To-Dos. The problem I am having is that our instructors have been instructed to write the exams in NCLEX format. This poses an issue for me, because the material was not well presented. We were kinda rushed through the subject matter, and well I just don't get the issue of Onset/Peak/Duration. I've gone online to a couple of sites, but it's just confusing me even more. Is there a dummy's guide to insulin and the conditions that surround them? Any references that won't confuse me will be much appreciated!!!! :bow:

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Ok,

Here's an example of a question:

A diabetic client receives a combo of regular an NPH insulin at 0700 hours. The nurse teaches the client to be alert for signs of hypoglycemia at:

1.)1200 and 1300 hours

2.)1100 and 1700 hours

3.)1000 and 2200 hours

4.)0800 and 1100 hours

This is an example of why I'm confused. Can anyone give me the answer and the reason why, please!!! I have the answer, but I understand WHY!!!

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Don't the body's normal sugar levels dip at 10 and 2?

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unterpleichfeld said:
Don't the body's normal sugar levels dip at 10 and 2?

OK, I'm even more confused.:banghead:

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Specializes in icu, er, transplant, case management, ps.
Delta18 said:
OK,

Here's an example of a question:

A diabetic client receives a combo of regular an NPH insulin at 0700 hours. The nurse teaches the client to be alert for signs of hypoglycemia at:

1.)1200 and 1300 hours

2.)1100 and 1700 hours

3.)1000 and 2200 hours

4.)0800 and 1100 hours

This is an example of why I'm confused. Can anyone give me the answer and the reason why, please! I have the answer, but I understand WHY!

I am sorry but I believe none of these answers are correct. I take NPH and occasionally regular insulin with it. I have to watch for a hypoglycemic attack at the time at which my NPH begins to peak, six to ten hours. And if I have to take regular insulin, two to four hours after injecting. And from experience, when I have suffered a hypoglycemic attack, it has been generally six to eight hours after injecting the NPH. If one suffers from not taking in enough carbohydrates to match their insulin dose, it usually happens at the peak times of the insulin.

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here is something that may help also:

cold and clammy....need some candy

hot and dry.... sugar's high

insulin:

rapid: (lispro) onset:

short: (regular) onset: 1/2hr-1hr peak: 2-3 hr duration: 4-6 hr

intermediate: (nph or lente) onset: 2hr peak: 6-12 duration: 16-24

long acting: (ultralente) onset: 4-6 hr peak: 12-16hr duration: >24 hrs

very long: (lantus) onset: 1 hr peak: none duration: 24 hr continuous

jadu1106 :)

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jadu1106 said:
here is something that may help also:

cold and clammy....need some candy

hot and dry.... sugar's high

insulin:

rapid: (lispro) onset:

short: (regular) onset: 1/2hr-1hr peak: 2-3 hr duration: 4-6 hr

intermediate: (nph or lente) onset: 2hr peak: 6-12 duration: 16-24

long acting: (ultralente) onset: 4-6 hr peak: 12-16hr duration: >24 hrs

very long: (lantus) onset: 1 hr peak: none duration: 24 hr continuous

jadu1106 ?

thank you! this helps :yeah: but what about the question?!? can anyone figure out how they arrived at their answer of 1100 and 1700???

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delta18 said:
thank you! this helps :yeah: but what about the question?!? can anyone figure out how they arrived at their answer of 1100 and 1700???

hi!

I am glad that helps....is that the answer? I would think the answer is between 1200-1300...since the patient is getting regular and nph...it doesn't make sense for hypoglycemic effects to start at 1100...that is 4 hrs after the insulin dose is given....let me address the question to daytonite, she is excellent at explaining things even to graduates like me...who should know the correct answer....so I will get back to you as soon as I can get the rationale for the answer.

jadu1106

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Specializes in Rural - we do it all!!!.
Delta18 said:
OK,

Here's an example of a question:

A diabetic client receives a combo of regular an NPH insulin at 0700 hours. The nurse teaches the client to be alert for signs of hypoglycemia at:

1.)1200 and 1300 hours

2.)1100 and 1700 hours

3.)1000 and 2200 hours

4.)0800 and 1100 hours

This is an example of why I'm confused. Can anyone give me the answer and the reason why, please! I have the answer, but I understand WHY!

First, all of the questions will be formatted in somewhat the same manner. Your nursing instructors are using your time in nursing school to help you understand how to decipher the questions. Nursing school is different from any other school that you've had. You've got to think about the answer!

So, don't panic.

What does the question tell you? A diabetic client receives a combo of regular an NPH insulin at 0700 hours.

So, what do you know from the first part of the question?

You've got a diabetic client, that receives insulin injections.

The 0700 insulin injection contains two different types of insulin.

What does the question want you to answer? The nurse teaches the client to be alert for signs of hypoglycemia at:

What causes hypoglycemia? The peaking of the insulin...

Now, apply what you know about insulin. Each type of insulin peaks at a different time.

When does regular insulin peak? 2-5 hours.

When does NPH insulin peak? 6-12 hours.

So, your patient should peak, with the regular insulin between 0700+0200=0900 and 0700+0500=1200.

And your patient should peak, with the NPH insulin between

0700+0600=1300 and 0700+1200=1900.

Which answer fits these two parameters? That is with hypoglycemia risk r/t peaking of insulin ?

That is, which answer peaks between 0900 and 1200. And peaks between 1300 and 1900?

1.)1200 and 1300 hours

2.)1100 and 1700 hours

3.)1000 and 2200 hours

4.)0800 and 1100 hours

It looks like B.

Does this help?

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It's because of the peak times. The risk for hypoglycemia is the highest when the insulins peak.

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catlover13 said:
First, all of the questions will be formatted in somewhat the same manner. Your nursing instructors are using your time in nursing school to help you understand how to decipher the questions. Nursing school is different from any other school that you've had. You've got to think about the answer!

So, don't panic.

What does the question tell you? A diabetic client receives a combo of regular an NPH insulin at 0700 hours.

So, what do you know from the first part of the question?

You've got a diabetic client, that receives insulin injections.

The 0700 insulin injection contains two different types of insulin.

What does the question want you to answer? The nurse teaches the client to be alert for signs of hypoglycemia at:

What causes hypoglycemia? The peaking of the insulin...

Now, apply what you know about insulin. Each type of insulin peaks at a different time.

When does regular insulin peak? 2-5 hours.

When does NPH insulin peak? 6-12 hours.

So, your patient should peak, with the regular insulin between 0700+0200=0900 and 0700+0500=1200.

And your patient should peak, with the NPH insulin between

0700+0600=1300 and 0700+1200=1900.

Which answer fits these two parameters? That is with hypoglycemia risk r/t peaking of insulin ?

That is, which answer peaks between 0900 and 1200. And peaks between 1300 and 1900?

1.)1200 and 1300 hours

2.)1100 and 1700 hours

3.)1000 and 2200 hours

4.)0800 and 1100 hours

It looks like B.

Does this help?

DEAR GOD! THANK YOU! THANK YOU THANK YOU THANK YOU!:bow::yeah:

If you've got anymore tips regarding insulin PLEASE pass them along! You've got a FAN in ME!:up:

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Specializes in Rural - we do it all!!!.
Delta18 said:
DEAR GOD! THANK YOU! THANK YOU THANK YOU THANK YOU!:bow::yeah:

If you've got anymore tips regarding insulin PLEASE pass them along! You've got a FAN in ME!:up:

It's not just this question...all your questions will follow this same format.

The question will give you information. Take the time to read it! And then the question will ask you for something. Figure out what the question is asking for.

It just takes practice. And a different way of thinking about testing. And it will help you when you do sit for the NCLEX.

:paw:

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