An older adult client with type 2 diabetes mellitus is prescribed 12\text{ units} of regul… — NCLEX-PN

An older adult client with type 2 diabetes mellitus is prescribed $12\text{ units}$ of regular insulin and $20\text{ units}$ of NPH insulin subcutaneously. Arrange the steps the practical nurse must follow to safely prepare this mixed dose in a single syringe in the correct chronological order.

1Roll the vial of NPH insulin gently between the palms of the hands.
2Scrub the rubber stoppers of both insulin vials with alcohol wipes and allow them to dry.
3Inject $20\text{ units}$ of air into the NPH insulin vial without touching the fluid.
4Inject $12\text{ units}$ of air into the regular insulin vial.
5Invert the regular insulin vial and withdraw exactly $12\text{ units}$ of insulin into the syringe.
6Insert the needle into the NPH insulin vial, invert it, and withdraw exactly $20\text{ units}$ of insulin.

Answer

The correct sequence is: Roll the NPH vial, cleanse both stoppers, inject air into NPH, inject air into regular, withdraw regular, then withdraw NPH.

When mixing NPH and regular insulin, the standard safety protocol is 'clear before cloudy'. The practical nurse must first suspend the NPH by rolling, disinfect both vials, and inject the required air into the NPH vial without touching the liquid. Next, the nurse injects air into the regular insulin vial and immediately draws up the regular (clear) insulin. Finally, the nurse draws up the NPH (cloudy) insulin. This strict sequence prevents contamination of the rapid-acting regular insulin vial with the longer-acting NPH insulin.

Step-by-Step Solution

Roll the vial of NPH insulin gently between the palms.

The cloudy suspension is mixed evenly.

NPH insulin settles when resting. Rolling prevents bubbles that shaking would cause, ensuring an accurate dose.

Scrub the rubber stoppers of both insulin vials with alcohol wipes.

The entry points on the vials are disinfected.

This prevents the introduction of pathogens into the sterile vials when they are punctured.

Inject

20\text{ units}

of air into the NPH insulin vial.

The pressure in the NPH vial is equalized without contaminating the needle.

Air prevents a vacuum. The needle must stay above the fluid so it remains clean for the regular insulin vial.

Inject

12\text{ units}

of air into the regular insulin vial.

The pressure in the regular insulin vial is equalized.

This allows for easy withdrawal of the medication. The needle is left in place for the next step.

Withdraw exactly

12\text{ units}

of regular insulin.

The syringe contains the clear, short-acting insulin.

Regular insulin must be drawn first ('clear before cloudy') to prevent NPH from contaminating the regular insulin vial.

Insert the needle into the NPH insulin vial and withdraw exactly

20\text{ units}

The syringe contains a total of

32\text{ units}

of mixed insulin.

NPH is drawn last. Extreme precision is required because if too much is withdrawn, it cannot be pushed back without contaminating the vial.

Key Concept

Safe sequence for mixing regular (short-acting) and NPH (intermediate-acting) insulin.

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