Examkin

Question

Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer a mixture of regular insulin and NPH insulin to a client with type 2 diabetes mellitus. Arrange the following steps for drawing up these insulins in a single syringe in the correct chronological order.

  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. 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 for mixing insulin 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 (cloudy) and regular (clear) insulin, the standard safety protocol is 'clear before cloudy' for drawing the medication, but 'cloudy before clear' for injecting air. The sequence begins by rolling the NPH suspension to mix it. Next, air is injected into the NPH vial without touching the fluid. The needle is removed, and air is then injected into the regular insulin vial. The regular (clear) insulin is drawn up first to prevent contaminating the rapid/short-acting vial with the longer-acting NPH protein. Finally, the NPH (cloudy) insulin is drawn into the syringe.

Step-by-Step Solution

1
Roll the NPH insulin vial gently between the palms of the hands.
The NPH insulin suspension is evenly mixed without creating air bubbles.
NPH is a suspension that settles when stationary; rolling ensures an accurate dose while avoiding foam that shaking would cause.
2
Inject air equal to the prescribed dose into the NPH insulin vial.
The NPH vial is pressurized for later withdrawal.
Injecting air prevents a vacuum from forming when fluid is removed. Doing this first prevents contamination of the clear insulin.
3
Inject air equal to the prescribed dose into the regular insulin vial.
The regular insulin vial is pressurized.
This prepares the clear insulin vial for immediate fluid withdrawal in the following step.
4
Invert the regular insulin vial and withdraw the prescribed dose.
The syringe contains the required amount of regular (clear) insulin.
Drawing the clear insulin first guarantees that no cloudy insulin is accidentally introduced into the rapid- or short-acting insulin vial.
5
Insert the needle into the NPH insulin vial and withdraw the prescribed dose.
The total combined dose is now in the syringe.
The cloudy insulin is drawn last. Since the vial was already pressurized with air in step 2, fluid can be withdrawn easily.

Key Concept

Safe Medication Administration: Mixing Insulins (Clear Before Cloudy)
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic