Examkin

Question

Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is preparing a single syringe containing both NPH insulin and regular insulin for a client with diabetes mellitus. In what order should the PN perform the following steps to safely prepare the medication? (Arrange the actions from first to last).

  1. 1Roll the NPH insulin vial gently between the palms of the hands.
  2. 2Inject an amount of air equal to the prescribed dose into the NPH insulin vial.
  3. 3Inject an amount of air equal to the prescribed dose into the regular insulin vial.
  4. 4Invert the regular insulin vial and withdraw the prescribed dose.
  5. 5Insert the needle into the NPH insulin vial and withdraw the prescribed dose.

Answer

The correct sequence 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.
When mixing NPH (intermediate-acting, cloudy) and regular (short-acting, clear) insulins, the standard safety protocol is 'clear before cloudy'. The correct sequence ensures the regular insulin vial is not contaminated by NPH insulin. First, the NPH suspension must be rolled to mix. Then, air is injected into the NPH vial, followed by air into the regular vial. The regular insulin is then withdrawn, and finally, the NPH insulin is withdrawn.

Step-by-Step Solution

1
Roll the NPH insulin vial gently between the palms of the hands.
The suspension is evenly mixed without creating bubbles.
NPH insulin contains particles that settle at the bottom and must be resuspended evenly for accurate dosing.
2
Inject an amount of air equal to the prescribed dose into the NPH insulin vial.
Air pressure in the NPH vial is increased without withdrawing medication.
Injecting air prevents a vacuum from forming when withdrawing the dose later. This is done first to avoid cross-contamination once the needle has regular insulin on it.
3
Inject an amount of air equal to the prescribed dose into the regular insulin vial.
Air pressure in the regular insulin vial is increased.
This prepares the regular insulin vial for immediate withdrawal of the medication.
4
Invert the regular insulin vial and withdraw the prescribed dose.
The correct dose of regular insulin is now in the syringe.
Regular (clear) insulin is always drawn up before NPH (cloudy) insulin to prevent the NPH insulin from contaminating the regular insulin vial, which could alter the action of the rapid-acting insulin.
5
Insert the needle into the NPH insulin vial and withdraw the prescribed dose.
The total mixed dose is now in the syringe.
The cloudy insulin is drawn up last to complete the mixture safely.

Key Concept

Safe Preparation of Mixed Insulins
Rate this question

Topics

Pharmacological Therapies

More questions from this topic