Insulin

The exam loves timing questions — it names an insulin and asks when hypoglycemia is most likely or when the tray must arrive. Memorize the windows: rapid-acting (lispro/aspart) peaks ~1 hr, but its fast onset means the tray must already be there, so give it within ~15 minutes of food; regular peaks ~2–3 hr; NPH peaks ~4–12 hr; glargine is peakless, never the answer to “when will the client crash?” Spot the hypoglycemia stem (shaky, diaphoretic, confused): if the client is alert and can swallow, give 15 g fast carbs and recheck in 15 minutes (rule of 15) — reaching for IV dextrose or glucagon for an alert client is the trap.

Insulin and heparin are both high-alert drugs, so high-risk doses (especially IV) get an independent two-nurse check per policy. Insulin is drawn in a U-100 insulin syringe, never a tuberculin or standard syringe. And unlike heparin, titrated to a clotting lab (aPTT), insulin is held for a low potassium or a normal/low glucose — it only drives those values lower.