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Difficulty: EasyPharmacological and Parenteral Therapies

A nurse is preparing to mix and administer a prescribed dose of Regular insulin and NPH insulin in a single syringe. Arrange the steps of this procedure in the correct sequence from first to last.

  1. 1Roll the NPH insulin vial between the palms of the hands.
  2. 2Inject a volume of air equal to the prescribed dose into the NPH insulin vial.
  3. 3Inject a volume of air equal to the prescribed dose into the Regular insulin vial.
  4. 4Withdraw the prescribed dose of Regular insulin.
  5. 5Withdraw the prescribed dose of NPH insulin.

Answer

The correct sequence for mixing insulins is to gently roll the NPH vial, inject air into the NPH vial, inject air into the Regular insulin vial, draw up the Regular insulin, and finally draw up the NPH insulin (Clear before Cloudy).
When mixing insulin, the fundamental rule is 'clear before cloudy' (Regular before NPH) to avoid contaminating the short-acting insulin with the intermediate-acting insulin. The correct sequence ensures the vials are pressurized properly while maintaining sterility and preventing cross-contamination.

Step-by-Step Solution

1
Roll the NPH insulin vial between the palms.
The cloudy suspension is thoroughly mixed.
NPH insulin contains particles that settle at the bottom; rolling prevents bubble formation that can alter the dose measurement.
2
Inject air into the NPH insulin vial.
The NPH vial is pressurized.
Pressurizing the vial prevents a vacuum, and doing this first prevents contamination of the clear insulin.
3
Inject air into the Regular insulin vial.
The Regular insulin vial is pressurized.
The needle can now remain in this vial to draw the first medication.
4
Withdraw the prescribed dose of Regular insulin.
The clear insulin is drawn into the syringe.
Drawing clear insulin before cloudy insulin prevents contamination of the rapid-acting or short-acting insulin vial.
5
Withdraw the prescribed dose of NPH insulin.
Both insulins are successfully mixed in the syringe.
This completes the combined dose preparation safely.

Key Concept

Safe Parenteral Medication Administration: Mixing Insulins
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Topics

Pharmacological and Parenteral Therapies

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