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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is preparing to administer 8 units of regular insulin and 14 units of NPH insulin subcutaneously to a client with diabetes mellitus. In which order should the PN perform the following steps to prepare the medication? Arrange the actions in the correct sequence from first to last.

  1. 1Roll the NPH insulin vial gently between the palms of the hands.
  2. 2Inject air equal to the prescribed dose into the NPH insulin vial.
  3. 3Inject air equal to the prescribed dose into the regular insulin vial.
  4. 4Withdraw the prescribed dose of regular insulin from its vial.
  5. 5Withdraw the prescribed dose of NPH insulin from its vial.

Answer

The correct sequence for mixing insulins is: roll the NPH vial, inject air into the NPH vial, inject air into the regular insulin vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
To safely mix regular and NPH insulin, the nurse must follow the 'clear before cloudy' sequence to prevent contaminating the rapid-acting regular insulin with the longer-acting NPH insulin. The sequence involves preparing the suspension, pressurizing both vials (starting with NPH), and then withdrawing the insulins (starting with regular).

Step-by-Step Solution

1
Roll the NPH insulin vial gently between the palms.
The suspension is evenly mixed without creating air bubbles.
NPH insulin settles when standing and must be resuspended to ensure an accurate dose.
2
Inject air equal to the prescribed dose into the NPH insulin vial.
The NPH vial is pressurized.
Injecting air prevents a vacuum. This is done first so the needle does not carry regular insulin into the NPH vial.
3
Inject air equal to the prescribed dose into the regular insulin vial.
The regular insulin vial is pressurized.
This prepares the vial for immediate withdrawal of the medication without creating a vacuum.
4
Withdraw the prescribed dose of regular insulin from its vial.
The regular insulin is drawn into the syringe.
Regular insulin (clear) is drawn first to prevent it from being contaminated by the NPH insulin (cloudy).
5
Withdraw the prescribed dose of NPH insulin from its vial.
Both insulins are accurately mixed in the syringe.
NPH is drawn last because any excess cannot be injected back into the vial without contaminating it with regular insulin.

Key Concept

Safe medication preparation: mixing clear (regular) and cloudy (NPH) insulins in a single syringe.
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Topics

Pharmacological Therapies

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