JIPMER Pondicherry NO - 2022
Medical & Surgical Nursing
Hard
A patient is receiving 10 units of insulin with 50% dextrose. The on-duty nursing officer would understand that the patient may develop which of the possible complications?
Appeared in: JIPMER Pondicherry NO - 2022
Explanation
- Low potassium level.
- Insulin stimulates the sodium-potassium (Na+/K+) pump on cell membranes, which causes potassium to shift from the bloodstream into the cells.
- This intracellular shift results in a decrease in the serum potassium concentration, leading to hypokalemia.
- The 50% dextrose is administered concurrently to prevent the patient from developing hypoglycemia (low blood sugar) as a result of the insulin.
- While this combination is used to treat high potassium (hyperkalemia), an excessive drop in potassium is a primary complication to monitor for.
Why Other Options Were Wrong
- Option A: A high potassium level (hyperkalemia) is the indication for administering insulin and dextrose, not a complication of the treatment. The therapy is designed to lower potassium levels.
- Option C: Insulin and dextrose therapy does not directly cause an increase in serum calcium levels (hypercalcemia).
- Option D: Insulin and dextrose therapy does not directly cause a decrease in serum calcium levels (hypocalcemia).
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Complications of Insulin and Dextrose Therapy to guide bedside assessment, documentation, and the next nursing action.
- This is a critical patient safety concept. Administering insulin for hyperkalemia requires vigilant monitoring to prevent iatrogenic, life-threatening hypokalemia and hypoglycemia.
- Nurses must place patients receiving this therapy on a cardiac monitor to watch for ECG changes indicative of hypokalemia, such as flattened T-waves, ST depression, and the presence of U-waves.
- Frequent blood glucose monitoring is mandatory to ensure the dextrose infusion is adequate and to prevent neurological complications from hypoglycemia.
How to Approach the Question
- First, identify the medications being administered: insulin and 50% dextrose.
- Recall the primary physiological effects of insulin. Beyond its role in glucose uptake, remember that insulin also drives potassium into cells.
- Analyze the purpose of the combination. Insulin is given to lower potassium. Dextrose is given to prevent the resulting hypoglycemia.
- Consider the potential complications. The intended effect is to lower potassium, so an excessive or overly rapid drop (hypokalemia) is a major risk.
- Evaluate the options: 'High potassium level' is the reason for the treatment. 'High/Low calcium level' are not directly affected. 'Low potassium level' is the most direct and significant potential complication of this therapy.
Concept Tested & Keywords
- Concept Tested: Complications of Insulin and Dextrose Therapy
- Stem keywords: insulin, 50% dextrose, complications
- Lead-in keywords: may develop
- Clinical cues: Administration of insulin with dextrose is a standard treatment for hyperkalemia.
- Negative lead-in flag: false
Question ID
QZU_scCaj8ZUNaKQHEjxNG
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 52-54
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 568-570
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1048-1050
Practise the full JIPMER Pondicherry NO - 2022
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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