When mixing two different types of insulin, which of the following principles is recommended best practice?

The correct volume of long-acting insulin is drawn-up first

Inject air into the short-acting insulin first

Two medications cannot be mixed in the same syringe

Inject air into the long-acting insulin first

Answer and Explanation

The Correct Answer is B

A. The correct volume of long-acting insulin is drawn-up first: Long-acting insulin should never be drawn up first because it must not be contaminated with short-acting insulin. Contamination can alter the pharmacokinetics of the long-acting insulin, reducing its effectiveness and increasing the risk of hypoglycemia.

B. Inject air into the short-acting insulin first: Best practice when mixing insulins in the same syringe is to inject air into the long-acting insulin first and then inject air into the short-acting insulin. After this, the short-acting insulin is drawn up first, followed by the long-acting insulin. This prevents contaminating the long-acting insulin and ensures safe dosing.

C. Two medications cannot be mixed in the same syringe: While some insulin types cannot be mixed, many combinations (short-acting with intermediate-acting) are compatible. Saying they cannot be mixed is incorrect; proper technique allows safe mixing in a single syringe.

D. Inject air into the long-acting insulin first: While air is injected first into the long-acting vial to equalize pressure, it must not be drawn into the syringe before the short-acting insulin. Drawing up the long-acting insulin first can compromise the mixture. The correct sequence is: inject air into both vials, draw up short-acting insulin first, then draw up long-acting insulin.

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Correct Answer is B

Explanation

A. Enteric-coated: Enteric-coated tablets are designed to resist stomach acid and dissolve in the intestines. Crushing them destroys the coating, which can result in gastric irritation, reduced efficacy, or toxicity. Therefore, these should never be crushed for enteral administration.

B. Tablet: Regular tablets without special coatings can usually be crushed and administered via an enteral tube. Crushing allows the medication to be dissolved or suspended for safe passage through the tube while maintaining therapeutic effect, provided the drug’s properties are compatible with enteral administration.

C. Buccal: Buccal medications are intended to dissolve slowly in the mouth for systemic absorption through the oral mucosa. Crushing buccal tablets for enteral administration alters absorption, onset, and effectiveness, making this inappropriate.

D. Sustained-release: Sustained-release (extended-release) formulations are designed to release the drug gradually over time. Crushing them results in rapid release of the full dose, increasing the risk of toxicity and reducing the intended therapeutic effect.

A. Antibiotics and anticoagulants B. Narcotics and antibiotics C. Cardiac and antihypertensives D. Insulins and controlled drugs

Correct Answer is B

Explanation

A. Antibiotics and anticoagulants: While some antibiotics may have duration limits, anticoagulants such as heparin or warfarin are continued based on clinical indication and laboratory monitoring rather than automatic stop policies. Anticoagulation therapy is often long-term or condition-specific, making routine automatic discontinuation inappropriate.

B. Narcotics and antibiotics: Narcotics (controlled substances) and antibiotics commonly have automatic stop orders in many institutions to prevent prolonged, unnecessary use. Narcotics carry risks of dependence, oversedation, and respiratory depression, while antibiotics require duration monitoring to reduce antimicrobial resistance and adverse effects.

C. Cardiac and antihypertensives: Cardiac medications and antihypertensives are usually chronic therapies intended for ongoing management of cardiovascular disease. Abrupt discontinuation due to an automatic stop order could result in rebound hypertension, arrhythmias, or ischemic events, making routine automatic discontinuation unsafe.

D. Insulins and controlled drugs: Although controlled drugs may be subject to automatic stop policies, insulin is not included. Insulin therapy is essential for glycemic control and must be administered consistently; automatic discontinuation could precipitate hyperglycemia or diabetic ketoacidosis.

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When mixing two different types of insulin, which of the following principles is recommended best practice?

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