The patient needs both regular insulin and NPH insulin to be administered subcutaneously. The nurse will mix both insulins in the same syringe.
What is the correct technique for preparing this insulin order?
Draw up one-half of the NPH insulin followed by one-half of the regular insulin and repeat.
Draw up one-half of the regular insulin followed by one-half of the NPH insulin and repeat.
Draw up the NPH insulin into the insulin syringe followed by the regular insulin.
Draw up the regular insulin into the insulin syringe followed by the NPH insulin.
The Correct Answer is D
The correct technique for preparing this insulin order is to follow these steps¹²:
- Perform hand hygiene and put on gloves.
- Mix NPH (cloudy) insulin by gently rotating the vial between the palms of your hands. Do not shake the vial.
- Clean the tops of both vials with alcohol swabs and let them dry.
- Draw up the amount of air equal to the dose of NPH insulin into a syringe. Inject the air into the NPH vial without touching the needle to the solution. Withdraw the needle and syringe without drawing up any insulin. This will create positive pressure in the NPH vial and make it easier to draw up later.
- Draw up the amount of air equal to the dose of regular (clear) insulin into the same syringe. Inject the air into the regular vial and invert the vial. Make sure the needle tip is below the fluid level and draw up slightly more than the dose of regular insulin. Tap the syringe gently to remove any air bubbles and push out any excess insulin to get the exact dose. Withdraw the needle and syringe from the regular vial.
- Reinsert the needle and syringe into the NPH vial without touching the needle to the solution. Invert the vial and draw up slightly more than the dose of NPH insulin. Tap the syringe gently to remove any air bubbles and push out any excess insulin to get the exact dose. Withdraw the needle and syringe from the NPH vial.
- Check that you have the correct doses of both insulins in one syringe. The total volume should be equal to the sum of both doses.
- Administer the dose within 5 to 10 minutes after drawing up because regular insulin binds to NPH and this decreases its action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This numeric form is appropriate, according to the Joint Commission, because it does not use a trailing zero after a decimal point, which is a common cause of medication errors and should be avoided. A trailing zero may be misread or misinterpreted as a larger dose or omited altogether, resulting in a 10-fold overdose or underdose, respectively. For example, when prescriptions have been writen for "Coumadin 1.0 mg," patients have received 10 mg in error¹². Therefore, the Joint Commission requires that a trailing zero may be used only when required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report the size of lesions, or catheter/tube sizes. It may not be used in medication orders or other medication-related documentation.
The other options are not appropriate numeric forms because:
a) 3.0 uses a trailing zero after a decimal point, which poses a risk of confusion or error.
b) 0.30 uses a trailing zero after a decimal point, which poses a risk of confusion or error.
c) 0.03 is not equivalent to 0.3, as it is 10 times smaller.
Correct Answer is C
Explanation
To find the milliliters per hour, you need to calculate the following:
- The patient's weight in kilograms
- The dose of Principen in milligrams
- The infusion rate in milliliters per hour using the formula: Infusion rate (mL/h) = (Total volume (mL) x Flow factor (gt/mL)) / Time (min) x 60 min/h
First, convert the patient's weight from pounds to kilograms by dividing by 2.2:
22 lb / 2.2 = 10 kg
Next, multiply the patient's weight by the dose of Principen per kilogram to get the total dose in milligrams:
10 kg x 25 mg/kg = 250 mg
Then, use the formula for infusion rate to find how many milliliters per hour the IV pump should deliver:
Infusion rate (mL/h) = (Total volume (mL) x Flow factor (gt/mL)) / Time (min) x 60 min/h
Since the medication is prepared in 50 mL of solution and the infusion time is 30 minutes, plug in these values into the formula:
Infusion rate (mL/h) = (50 mL x 1 gt/mL) / 30 min x 60 min/h
Simplify and solve for the infusion rate:
Infusion rate (mL/h) = 100 mL/h
Therefore, the nurse should administer **100 mL/h** to infuse Principen 250 mg over 30 minutes.
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