A nurse is preparing to administer insulin to a client with diabetes mellitus. The nurse draws up 10 units of regular insulin and 20 units of NPH insulin in the same syringe. Which of the following actions should the nurse take next?

A high INR indicates that the client is at risk of bleeding due to excessive anticoagulation. The nurse should first assess for signs of bleeding, such as bruising, petechiae, hematuria, or melena.

Then, the nurse should notify the provider and follow orders to reverse the anticoagulation effect, such as administering vitamin K or fresh frozen plasma.

Holding the next dose of warfarin may be appropriate, but it is not the priority action.

Incorrect choices:

a) Administer vitamin K: Vitamin K is an antidote for warfarin overdose, but it should not be given without a provider's order. It may also take several hours to reverse the anticoagulation effect.

b) Notify the provider: Notifying the provider is an important step, but it is not the first action. The nurse should assess the client's condition before calling the provider.

c) Hold the next dose of warfarin: Holding the next dose of warfarin may prevent further anticoagulation, but it does not address the current risk of bleeding. The nurse should assess and intervene for bleeding before holding the medication.

When mixing two types of insulin in one syringe, the nurse should follow the mnemonic RN or "regular before NPH". This means that the nurse should first inject air into the NPH vial, then inject air into the regular vial, then withdraw regular insulin from the vial, and finally withdraw NPH insulin from the vial. This order prevents contamination of the regular insulin with NPH insulin and ensures accurate dosing.

Incorrect choices:

a) Inject air into the NPH vial: This is correct, but it is not the next action. The nurse should inject air into the NPH vial before drawing up any insulin.

c) Withdraw NPH insulin from the vial: This is incorrect and can lead to a medication error. The nurse should withdraw NPH insulin after withdrawing regular insulin.

d) Withdraw regular insulin from the vial: This is correct, but it is not the next action. The nurse should inject air into the regular vial before withdrawing regular insulin.