Examkin

Question

Difficulty: MediumPharmacological Therapies

A client with type 2 diabetes mellitus is prescribed a combined subcutaneous injection of regular and NPH insulin. Place the following actions the nurse must take to draw up the medication in the correct chronological sequence.

  1. 1Roll the NPH insulin vial gently between the palms.
  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 amount of regular insulin.
  5. 5Withdraw the prescribed amount of NPH insulin.

Answer

The correct sequence for mixing insulins is to roll the NPH vial, inject air into the NPH vial, inject air into the regular vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
To safely prepare a mixed dose of insulin, the nurse must follow the 'clear before cloudy' sequence. First, the NPH (cloudy) insulin is rolled to resuspend the particles. Then, air is injected into the NPH vial followed by the regular (clear) vial. The regular insulin is drawn up first to prevent contaminating the rapid-acting clear insulin with the longer-acting cloudy insulin. Finally, the NPH insulin is withdrawn.

Step-by-Step Solution

1
Resuspend the intermediate-acting insulin.
The cloudy suspension is mixed evenly without bubbles.
Rolling rather than shaking prevents bubble formation, which can cause dosing errors.
2
Pressurize both vials with air, starting with the intermediate-acting (cloudy) insulin.
Air is placed in both vials, leaving the needle in the regular insulin vial.
Pressurizing prevents a vacuum. Starting with NPH prevents contaminating the regular insulin needle.
3
Draw up the insulins, starting with the short-acting (clear) insulin.
Regular insulin is drawn up first, followed by NPH insulin.
Drawing clear before cloudy ensures the regular insulin vial is not contaminated by intermediate-acting insulin.

Key Concept

Safe Preparation of Mixed Insulins
Rate this question

Topics

Pharmacological Therapies

More questions from this topic