A nurse is preparing regular and NPH insulin in the same syringe for a client who has diabetes mellitus.
Which of the following actions should the nurse take?

Administer the mixture within 5 minutes of preparing it.

Inject air into the regular insulin vial before injecting air into the NPH vial.

Withdraw the NPH insulin before the regular insulin.

Shake both insulin vials for 2 minutes before withdrawing the doses.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Regular insulin is a rapid-acting insulin, and NPH is an intermediate-acting insulin. When mixed in the same syringe, the regular insulin molecules can bind to the protamine in the NPH suspension. This can alter the absorption profile of the regular insulin, delaying its onset of action. Administering the mixture within 5 minutes prevents this molecular interaction and ensures the regular insulin retains its rapid-acting properties.

Choice B rationale

It is crucial to inject air into the NPH insulin vial first, followed by the regular insulin vial, and then withdraw the regular insulin dose before the NPH. This specific order prevents the NPH from contaminating the regular insulin vial with protamine, which would alter the potency and action profile of the regular insulin for future use. The regular insulin is then drawn up first.

Choice C rationale

The correct procedure is to withdraw the regular insulin before the NPH insulin. The sequence is to inject air into both vials, then draw up the clear, rapid-acting regular insulin first, followed by the cloudy, intermediate-acting NPH insulin. This sequence is essential to prevent contamination of the regular insulin vial with the NPH insulin, which could affect its rapid-acting properties.

Choice D rationale

Shaking insulin vials is generally discouraged as it can lead to the formation of air bubbles, which can result in an inaccurate dose. Instead of shaking, the NPH insulin vial should be gently rolled between the palms of the hands. This action warms the insulin and resuspends the particles uniformly without causing bubbles, ensuring an accurate and consistent dose is administered. .

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Correct Answer is B

Explanation

Choice A rationale

Diarrhea is a common side effect of clozapine, a second-generation antipsychotic medication. It is usually a mild to moderate symptom and does not typically warrant immediate reporting to the provider unless it is severe, persistent, or accompanied by other concerning symptoms like dehydration. It can often be managed with dietary adjustments or over-the-counter antidiarrheal medications, and it does not usually indicate a serious or life-threatening adverse reaction.

Choice B rationale

A fever in a client taking clozapine is a critical finding that must be immediately reported to the provider. Fever can be an early symptom of agranulocytosis, a severe and potentially fatal adverse effect characterized by a dangerously low white blood cell count. Agranulocytosis makes the client highly susceptible to severe infections. A fever may also indicate the onset of neuroleptic malignant syndrome, another serious and life-threatening condition.

Choice C rationale

Polyuria, which is excessive urination, can be a symptom of various conditions but is not a primary concern or contraindication for clozapine administration. It can be associated with increased fluid intake due to xerostomia (dry mouth), a common side effect of clozapine. It does not typically indicate a severe, life-threatening adverse effect like agranulocytosis or neuroleptic malignant syndrome, and thus does not require immediate reporting.

Choice D rationale

Diaphoresis, or excessive sweating, is a frequent side effect of clozapine. It is often related to the drug's anticholinergic effects and thermoregulatory dysfunction. While it can be uncomfortable for the client and may require management, it is not an immediate sign of a life-threatening condition like agranulocytosis or neuroleptic malignant syndrome. Therefore, it does not typically require an immediate report to the provider. *.

A. Insert a larger gauge IV catheter to prevent phlebitis. B. Choose the client's dominant arm for IV access whenever possible. C. Select a site proximal to previous venipuncture sites. D. Initiate IV access on the palmar side of the client's wrist.

Correct Answer is C

Explanation

Choice A rationale

While larger gauge catheters (e.g., 18-gauge) are used for rapid infusion, they also cause more trauma to the vein's intimal layer during insertion. This trauma can trigger a localized inflammatory response, increasing the risk of phlebitis, which is inflammation of the vein. Smaller gauge catheters (e.g., 22-24 gauge) cause less trauma and are preferred for routine fluid administration to prevent this complication.

Choice B rationale

The non-dominant arm is the preferred site for IV access whenever possible. Using the non-dominant arm allows the client to maintain more normal function and independence with daily activities, as they can still use their dominant hand without the restriction of the IV line. This also minimizes the risk of accidental dislodgement or trauma to the site.

Choice C rationale

Selecting a site proximal to previous venipuncture sites is the recommended practice. When a vein is punctured, it can cause localized inflammation and scar tissue formation distal to the site. Starting proximal allows for the use of a healthier segment of the vein, which improves the likelihood of successful insertion and reduces the risk of extravasation or phlebitis.

Choice D rationale

The palmar side of the client's wrist should be avoided for IV insertion. This area contains a high concentration of nerves and tendons, including the median nerve and radial artery. Inserting a catheter here increases the risk of nerve damage, which can lead to permanent numbness, tingling, or pain, and also increases the risk of arterial puncture. *.

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A nurse is preparing regular and NPH insulin in the same syringe for a client who has diabetes mellitus. Which of the following actions should the nurse take?

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A nurse is preparing regular and NPH insulin in the same syringe for a client who has diabetes mellitus.
Which of the following actions should the nurse take?