A nurse must give two types of insulin in the same syringe. What is the correct order of preparation?
Draw up cloudy first, then clear
Draw up air into both, then inject cloudy
Draw up clear first, then cloudy
Mix both in the vial before drawing up
The Correct Answer is C
When administering two types of insulin in the same syringe—typically a rapid- or short-acting insulin (clear) and an intermediate-acting insulin (cloudy)—nurses must follow a specific preparation sequence to maintain medication efficacy and safety. The proper order ensures that the short-acting insulin is not contaminated by the longer-acting one.
Rationale for correct answer:
3. Draw up clear first, then cloudy:
This is the safe and recommended technique. After injecting air into both vials (cloudy first, then clear), the nurse draws up the clear (short-acting) insulin before the cloudy (intermediate-acting). This avoids contamination and ensures proper insulin action.
Rationale for incorrect answer:
1. Draw up cloudy first, then clear:
This sequence risks contaminating the vial of short-acting insulin (clear) with intermediate-acting insulin (cloudy), altering its pharmacokinetics. Clear insulin must remain uncontaminated for precise glucose control.
2. Draw up air into both, then inject cloudy:
Air should be injected into both vials, but the order matters. Air should be injected into the cloudy vial first (without drawing), then into the clear vial, followed by drawing up the clear insulin. This option omits essential steps and implies drawing up insulin in the wrong order.
4. Mix both in the vial before drawing up:
Mixing both types of insulin in the vial is never recommended. Each type has a distinct action and formulation, and combining them in a vial compromises the effectiveness and stability of the insulins
Take-home points:
- Always draw up clear insulin before cloudy to prevent contamination of the fast-acting insulin.
- Inject air into the cloudy vial first, then into the clear vial before drawing insulin.
- Never mix insulins inside the vial—combining occurs only within the syringe following proper technique.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Selecting an appropriate intramuscular (IM) injection site in infants is a critical component of safe medication administration. The choice is guided by the infant’s muscle development, risk of nerve or vascular injury, and the volume of medication to be administered. At 3 months of age, only specific sites are safe and anatomically accessible.
Rationale for correct answer:
4. Vastus lateralis:
The vastus lateralis muscle, located on the anterolateral aspect of the thigh, is the safest and most well-developed IM site in infants under 12 months. It can accommodate the volume typically used in pediatric injections and avoids critical nerves or blood vessels, making it the preferred site for IM injections in a 3-month-old.
Rationale for incorrect answer:
1. Deltoid:
The deltoid muscle is underdeveloped in infants and is not recommended for IM injections until the child is older (typically over 18 months), due to its small size and limited capacity for medication volume.
2. Ventrogluteal:
Although the ventrogluteal site is preferred in adults and older children because of its safety and distance from major nerves and vessels, it requires more muscle development than is present in a 3-month-old infant. It may be used in older infants if muscle mass is sufficient, but not at 3 months.
3. Dorsogluteal:
This site should be avoided in infants and children due to the proximity to the sciatic nerve and major blood vessels, which poses a high risk of nerve injury or vascular complications.
Take-home points:
- The vastus lateralis is the safest and most appropriate site for IM injections in infants under 12 months.
- Avoid the deltoid and dorsogluteal sites in young infants due to insufficient muscle and risk of nerve damage.
- Site selection for IM injections in infants is based on muscle development, safety, and medication volume.
Correct Answer is C
Explanation
The Z-track method is a specialized intramuscular (IM) injection technique used to prevent medication leakage into subcutaneous tissues, which can lead to tissue irritation, staining, or discomfort. This technique is especially important when administering medications that are irritating or that can stain the skin, such as iron dextran. Nurses must understand the proper anatomical and procedural steps to ensure safe, effective delivery and minimize patient complications.
Rationale for correct answer:
C. Displace the skin laterally before injection and release after to seal medication:
This accurately describes the Z-track technique. Pulling the skin laterally creates a zigzag path that traps the medication in the muscle and prevents backflow into subcutaneous tissue, reducing irritation and promoting proper absorption.
Rationale for incorrect answers:
A. Insert needle at a 45° angle to minimize pain:
A 45° angle is used for subcutaneous injections, not intramuscular ones. IM injections, including the Z-track method, require a 90° angle to ensure the medication reaches deep muscle tissue, where it can be absorbed properly.
B. Inject medication slowly into subcutaneous tissue to prevent leakage:
The Z-track technique is not used for subcutaneous injections. Injecting into subcutaneous tissue is inappropriate for medications that require deep muscle absorption, and leakage is more likely to occur if the medication is not placed intramuscularly.
D. Use a tuberculin syringe for small volumes and precise dosing:
Tuberculin syringes are typically used for intradermal or very small subcutaneous injections, not for IM injections. The Z-track method requires a standard IM syringe and needle suitable for deep tissue penetration.
Take-home points:
- The Z-track technique is used to prevent medication leakage into subcutaneous tissue.
- Pulling the skin laterally before injection creates a sealed, zigzag path.
- Use a 90° angle with a proper IM needle—not a tuberculin syringe—for this method.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.