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NCLEX Question of the Day

Pharmacological and Parenteral Therapies

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Pharmacological and Parenteral Therapies QID 1241

A nurse is preparing to administer 10 units of NPH insulin and 6 units of regular insulin subcutaneously to a client with diabetes. What is the correct procedure for drawing up the insulin?

  1. Inject 6 units of air into the regular vial, withdraw 6 units of regular insulin, inject 10 units of air into the NPH vial, then withdraw 10 units of NPH insulin.

  2. Correct answer Inject 10 units of air into the NPH vial, inject 6 units of air into the regular vial, withdraw 6 units of regular insulin, then withdraw 10 units of NPH insulin.

  3. Inject 10 units of air into the NPH vial, withdraw 10 units of NPH insulin, inject 6 units of air into the regular vial, then withdraw 6 units of regular insulin.

  4. Draw up the NPH insulin first, then draw up the regular insulin in the same syringe.

Rationale

When mixing different types of insulin, such as NPH (intermediate-acting) and regular (short-acting), in the same syringe, the correct procedure prevents contamination of the short-acting insulin vial with the intermediate-acting insulin. Air is first injected into the longer-acting (NPH) insulin vial (equal to the dose), then air is injected into the shorter-acting (regular) insulin vial (equal to the dose). The shorter-acting (regular) insulin is drawn up first, followed by the longer-acting (NPH) insulin. This sequence (air in cloudy, air in clear, draw up clear, draw up cloudy) prevents contamination of the regular insulin with NPH.

The sequence described in the correct answer follows this principle. Drawing up NPH first (options 1 & 3) or withdrawing regular before injecting air into NPH (option 2) violates the correct procedure.

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