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A nurse is mixing NPH insulin and regular insulin prior to administration. Which of the following actions should the nurse take first?

Inject air into the vial with regular insulin in it.

Draw up the NPH insulin dose.

Inject air into the vial with NPH insulin in it.

Draw up the regular insulin dose.

Answer and Explanation

The Correct Answer is C

Answer: C

Rationale:

A) Inject air into the vial with regular insulin in it:

Injecting air into the vial of regular insulin is part of the correct procedure but not the initial step. This action is typically performed after the NPH insulin vial has been handled, as part of the process to prevent contamination and maintain the correct insulin types.

B) Draw up the NPH insulin dose:

Drawing up the NPH insulin dose should follow the initial steps of air injection. It is important to manage the insulin types in the correct sequence to ensure that the regular insulin remains uncontaminated by the NPH insulin.

C) Inject air into the vial with NPH insulin in it:

Injecting air into the NPH insulin vial first helps to equalize the pressure and avoid contamination when drawing up the insulin. This step is crucial to ensure that the NPH insulin is not inadvertently mixed with the regular insulin, maintaining the integrity of each type.

D) Draw up the regular insulin dose:

Drawing up the regular insulin dose should occur after air has been injected into both vials. This ensures that the NPH insulin is not drawn into the regular insulin syringe, which could affect the medication's efficacy.

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Correct Answer is A

Explanation

A. “The client will wear his reading glasses when drawing up a dose of insulin glargine”: This is an appropriate outcome. Ensuring correct dosage is crucial when administering insulin, and using reading glasses can help prevent errors, especially in older adults who may have vision impairment.

B. “The client will take an additional dose of insulin glargine prior to exercise”: This is not recommended. Insulin glargine is a long-acting insulin and its dose should not be adjusted based on exercise. Exercise can lower blood glucose levels, and taking an additional dose of insulin might lead to hypoglycemia.

C. “The client will administer insulin glargine before each meal”: Insulin glargine is a long-acting insulin that is typically administered once daily, not before each meal. Short-acting insulins are usually taken before meals.

D. “The client will use the deltoid muscle as an injection site”: Insulin is typically injected into subcutaneous tissue, not muscle. Common injection sites include the abdomen, thighs, buttocks, and the back of the upper arms. The deltoid muscle is not a typical injection site for insulin.

A. Check the client's glucose level. B. Collect the client's uric acid level. C. Monitor the client's thyroid function levels. D. Obtain the client's HDL level

Correct Answer is A

Explanation

A) Check the client's glucose level.
Correct. Metformin is an oral hypoglycemic agent used primarily for the treatment of type 2 diabetes. Administering metformin instead of metoprolol (a beta-blocker) could lead to hypoglycemia, especially if the client does not have diabetes or if their blood glucose levels are not monitored. The priority action after such an error is to check the client’s glucose level to identify and address any potential hypoglycemia promptly. Early detection and treatment of hypoglycemia are crucial to prevent severe complications such as confusion, seizures, or loss of consciousness.

B) Collect the client's uric acid level.
Uric acid levels are not relevant to the immediate effects of either metformin or metoprolol. Metformin can rarely cause lactic acidosis, especially in patients with renal impairment, but this is not the most immediate concern in an acute medication error. Collecting uric acid levels does not address the primary risk associated with the accidental administration of metformin.

C) Monitor the client's thyroid function levels.
Monitoring thyroid function levels is not directly related to the administration of metformin or metoprolol. While metformin can affect thyroid function tests, this is not an acute concern. The immediate priority should be monitoring for hypoglycemia and ensuring the client's safety.

D) Obtain the client's HDL level.
HDL (high-density lipoprotein) levels are part of a lipid profile and are not relevant to the acute effects of either metformin or metoprolol. Monitoring HDL levels would not address the potential hypoglycemic risk posed by the accidental administration of metformin.

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