A nurse is caring for a client with type 2 diabetes mellitus whose morning blood glucose l… — NCLEX-RN

A nurse is caring for a client with type 2 diabetes mellitus whose morning blood glucose level is $185 \text{ mg/dL}$ . The healthcare provider has prescribed $10 \text{ units}$ of regular insulin and $20 \text{ units}$ of NPH insulin to be administered subcutaneously. The nurse is preparing to mix both insulins in a single syringe. Arrange the following steps in the correct sequence for this procedure.

1Roll the vial of NPH insulin gently between the palms of the hands.
2Inject $20 \text{ units}$ of air into the NPH insulin vial.
3Inject $10 \text{ units}$ of air into the regular insulin vial.
4Withdraw $10 \text{ units}$ of regular insulin.
5Withdraw $20 \text{ units}$ of NPH insulin.

Answer

The correct sequence is to first 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.

The standard sequence for mixing insulins ensures the fast-acting (clear) insulin is not contaminated by the intermediate-acting (cloudy) insulin. The correct mnemonic is often 'Clear before Cloudy'. The process is: mix the cloudy insulin by rolling, inject air into the cloudy vial, inject air into the clear vial, draw from the clear vial, and finally draw from the cloudy vial.

Step-by-Step Solution

Roll the NPH vial gently between the palms.

The cloudy suspension is mixed uniformly.

Vigorous shaking causes air bubbles which can lead to inaccurate dosing; rolling mixes the particles safely.

Inject

20 \text{ units}

of air into the NPH vial, then remove the needle.

The NPH vial is pressurized for later withdrawal.

Air must be injected to prevent a vacuum, but the medication is not drawn yet to prevent contamination.

Inject

10 \text{ units}

of air into the regular insulin vial.

The regular insulin vial is pressurized.

Prepares the vial for immediate withdrawal of the medication without removing the needle.

Invert the vial and withdraw

10 \text{ units}

of regular insulin.

The clear insulin is drawn into the syringe.

Drawing the clear (short-acting) insulin first prevents it from being contaminated by the longer-acting insulin.

Insert the needle into the NPH vial and withdraw

20 \text{ units}

The total dose of

30 \text{ units}

is drawn into the syringe.

Drawing the cloudy insulin last completes the mixture without risking contamination of the rapid or short-acting insulin vial.

Key Concept

Mixing Clear and Cloudy Insulins

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