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

NRNP EXAM ms




Exam Solution ms




Insulin Management Part 2 Cartes 2026 A+ GRADE ASS ms ms ms ms ms ms ms ms




URED COMPLETE SOLUTIONS AND VERIFIED ANSWERS ms ms ms ms ms




(417CD)
ms




QUESTION 1 ms




insulin dose changes ms ms




ANSWER

*pattern management rules:* do not adjust dose on a "single" raised blood glucose; *base on glycemi
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms



c pattern ≥ 3 days* generally change only one component of insulin at a time: *address hypoglycemi
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms



a 1st* *aim for target fasting lvls next* adjust using a titration schedule (treat to target) or increase
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms



/ decrease insulin by 10%
ms ms ms ms




QUESTION 2 ms




case 1: stepwise intensification
ms ms ms




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
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms



w/ 5 units and titrate to goal 2. "500 rule"= 500/TDD= *insulin-carbohydrate ratio* i.
ms ms ms ms ms ms ms ms ms ms ms ms ms



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



at target but A1c is high (i.
ms ms ms ms ms ms



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



nd off to 10 U) before each meal 4. adjust based upon 2-
ms ms ms ms ms ms ms ms ms ms ms ms



hr PPG (postprandial) values 5. titrate insulin every 2-3 days to reach glycemic goals
ms ms ms ms ms ms ms ms ms ms ms ms ms




QUESTION 3 ms




conversion: QD Premix to MDI ms ms ms ms




ANSWER

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



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

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



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




QUESTION 4 ms




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




ANSWER

80 kg person w/ T2DM *70/30 premixed insulin BID:* 40 U before breakfast 20 U before dinner TD
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms



D= 60 U/d: the fasting glucose was at goal but wide glycemic excursions at other times how do you
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms m



convert this person to MDI?
s ms ms ms ms




QUESTION 5 ms




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




ANSWER

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



prandial) *supplementary insulin dose:* correction factor insulin (optional)-
ms ms ms ms ms ms ms



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



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




QUESTION 6 ms




starting basal bolus from scratch ms ms ms ms




ANSWER

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



meal = 80- ms ms



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



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




QUESTION 7 ms




calculating supplementary insulin dose or "correction dose": glucose correction factor
ms ms ms ms ms ms ms ms ms ms



(or = insulin sensitivity factor)
ms ms ms ms




ANSWER

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



unit of prandial insulin will decrease blood glucose insulin sensitivity factor (ISF)can be calculated
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms



using the *1500 rule* (regular insulin) or *1800 rule* (rapid acting analogs) 1800 rule: 1800/ TDD=
ms ms ms ms ms ms ms ms ms ms ms ms ms ms ms



glucose correction factor or sensitivity factor
ms ms ms ms ms ms




QUESTION 8 ms