NRNP 6531 primary care adults gerontology EXAM A+ GRADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ANSWERS

NRNP EXAM vc




Exam Solution vc




Insulin Management Part 2 Cartes 2026 A+ GRADE ASSU vc vc vc vc vc vc vc vc




RED COMPLETE SOLUTIONS AND VERIFIED ANSWERS (
vc vc vc vc vc vc




B7AE9)




QUESTION 1 vc




insulin dose changes vc vc




ANSWER

*pattern management rules:* do not adjust dose on a "single" raised blood glucose; *base on glycemic p
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



attern ≥ 3 days* generally change only one component of insulin at a time: *address hypoglycemia 1st*
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



*aim for target fasting lvls next* adjust using a titration schedule (treat to target) or increase/ decrease
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



insulin by 10% vc vc




QUESTION 2 vc




case 1: stepwise intensification
vc vc vc




ANSWER

case 1 is on LANTUS 50 units per day (TDD= 0.5 U/kg/ about 9.0 U) or *10% basal dose* ex. start w/ 5
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



units and titrate to goal 2. "500 rule"= 500/TDD= *insulin-carbohydrate ratio* i.
vc vc vc vc vc vc vc vc vc vc vc



d) plus metformin 1g BID: titrate basal insulin dose until→ 0.5 U/kg/d limit is reached *OR* FPG is at ta
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



rget but A1c is high (i.
vc vc vc vc vc



e. 500/50 is 10; give 1 U per 10g of CHO 3. if unable to count CHO: take 80% TDD / 3= 13 U (round off
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



to 10 U) before each meal 4. adjust based upon 2-hr PPG (postprandial) values 5. titrate insulin every 2-
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



3 days to reach glycemic goals
vc vc vc vc vc




QUESTION 3 vc




conversion: QD Premix to MDI vc vc vc vc




ANSWER

pt is using *70/30* premixed insulin titrated to *30 units per day= TDD*. fasting is at goal but daytime
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



control is poor. How do you convert to MDI? *basal insulin dose-
vc vc vc vc vc vc vc vc vc vc vc

, 70% x 30 units= 21 units; (use "unit for unit" conversion, so give 21 units basal glargine)* *bolus insuli
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



n- 30% x 30 units= 9 units- give 3 units before each meal and titrate every 2 to 3 days*
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc




QUESTION 4 vc




conversion: current 2 x Premix to MDI vc vc vc vc vc vc




ANSWER

80 kg person w/ T2DM *70/30 premixed insulin BID:* 40 U before breakfast 20 U before dinner TDD=
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



60 U/d: the fasting glucose was at goal but wide glycemic excursions at other times how do you convert
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc v



this person to MDI?
c vc vc vc




QUESTION 5 vc




starting basal-bolus from scratch: MDI subcutaneous insulin has 3 components
vc vc vc vc vc vc vc vc vc




ANSWER

*basic insulin dose:* (i.e the dose the pt will use everyday): 1. basal insulin 2. nutritional (bolus or pran
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



dial) *supplementary insulin dose:* correction factor insulin (optional)-
vc vc vc vc vc vc vc



rapid or short acting insulin given to correct pre-
vc vc vc vc vc vc vc vc vc



prandial hyperglycemia (i.e a high blood glucose lvls that is out range)
vc vc vc vc vc vc vc vc vc vc vc




QUESTION 6 vc




starting basal bolus from scratch vc vc vc vc




ANSWER

*basal insulin= 1/2 TDD:* give all of calculated basal insulin dose Q24h SMBG goal- FBS and pre-
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



meal = 80- vc vc



130 mg/dL *bolus doses= 1/2 TDD divided into # of meals per day* (ex: 3): prandial dose goal- 2h-
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



PPG < 180 mg/dL adjust for changes in daily intake of CHO (improves flexibility)
vc vc vc vc vc vc vc vc vc vc vc vc vc




QUESTION 7 vc




calculating supplementary insulin dose or "correction dose": glucose correction factor (o
vc vc vc vc vc vc vc vc vc vc



r = insulin sensitivity factor)
vc vc vc vc




ANSWER

the amt of glucose reduction (in mg/dL) to expect from 1 unit of prandial insulin ISF= Amt that one unit
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



of prandial insulin will decrease blood glucose insulin sensitivity factor (ISF)can be calculated using the
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc v



*1500 rule* (regular insulin) or *1800 rule* (rapid acting analogs) 1800 rule: 1800/ TDD= glucose corr
c vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc



ection factor or sensitivity factor
vc vc vc vc




QUESTION 8 vc