The nurse is caring for a client with an order for regular insulin and neutral protamine Hagedorn (NPH) insulin. When mixing the insulins in a single syringe, which action by the nurse is correct?
The nurse injects air into the regular insulin vial first.
The nurse withdraws the NPH insulin first.
The nurse gently rotates the NPH insulin vial.
The nurse selects a 3 mL syringe to mix insulins.
The Correct Answer is C
A. The nurse injects air into the regular insulin vial first: Air should be injected into each vial before drawing insulin to prevent creating a vacuum, but the order of air injection does not override the critical rule regarding drawing up insulin. The sequence of drawing the insulins is more important to maintain correct dosing.
B. The nurse withdraws the NPH insulin first: When mixing insulins, rapid-acting or short-acting insulin (e.g., regular insulin) should be drawn up first to avoid contaminating it with NPH, which could alter the onset and peak of the short-acting insulin. Drawing NPH first is incorrect practice.
C. The nurse gently rotates the NPH insulin vial: NPH insulin is a suspension that must be gently rolled to mix the insulin evenly before drawing it into the syringe. This ensures accurate dosing and prevents inconsistent absorption and unpredictable blood glucose effects.
D. The nurse selects a 3 mL syringe to mix insulins: While syringe size should match the insulin dose for accuracy, selecting a 3 mL syringe is not specific to the proper technique of mixing insulins and is less critical than ensuring proper vial mixing and correct order of withdrawal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. A client with type 2 diabetes with a blood glucose of 142: This blood glucose level is mildly elevated and generally within a range where insulin administration is safe and appropriate for glycemic control. Withholding insulin is not indicated unless hypoglycemia is present.
B. A client with type 1 diabetes with a blood glucose of 570: This is a critically high blood glucose level, indicating hyperglycemia or possible diabetic ketoacidosis. Administering insulin is essential to reduce blood glucose and prevent further complications.
C. A client with type 1 diabetes with a blood glucose of 56: Hypoglycemia is present, defined as a blood glucose below 70 mg/dL. Administering insulin in this situation could worsen hypoglycemia, potentially causing seizures, loss of consciousness, or death, so the dose should be withheld until glucose is corrected.
D. A client with type 1 diabetes with a blood glucose of 165: This blood glucose level is above normal but not acutely dangerous. Administering the prescribed insulin is appropriate to maintain glycemic control and prevent complications associated with hyperglycemia.
Correct Answer is D
Explanation
A. Identify the client using two identifiers: Client identification is a critical safety step prior to medication administration, not after the insulin has already been given. Performing this step post-administration does not enhance immediate safety or therapeutic monitoring.
B. Verify the insulin dose with another nurse: Dose verification is an essential safety measure before administration, especially with high-alert medications like insulin. After administration, verifying the dose again does not prevent adverse events that could occur from an incorrect dose already given.
C. Gently roll the vial between hands to mix: Mixing the insulin by rolling the vial is performed prior to drawing up the medication to ensure uniform concentration, not after injection. Post-administration rolling has no clinical benefit.
D. Continue to monitor the client for hypoglycemia: Monitoring for hypoglycemia is critical after administering rapid-acting insulin like lispro. Insulin lowers blood glucose quickly, and clients are at risk for symptoms such as sweating, shakiness, confusion, or seizures, making vigilant post-administration observation essential.
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