Editing Nursing Skills and Procedures – LPN Practice Questions (section)

==Question 8==
A licensed practical nurse is preparing to give a client both regular insulin and NPH insulin in one syringe. Which sequence is correct?
# Inject air into the regular vial, inject air into the NPH vial, withdraw NPH, then withdraw regular.
# Inject air into the NPH vial, inject air into the regular vial, withdraw regular, then withdraw NPH.
# Withdraw NPH first, then withdraw regular, then inject air into both vials.
# Withdraw regular first, then inject air into the NPH vial, then withdraw NPH.

'''Answer:''' 2 (B). Inject air into the NPH vial, inject air into the regular vial, withdraw regular, then withdraw NPH.

''Rationale:'' Air is injected into the cloudy intermediate-acting insulin first without touching the solution, then into the clear regular insulin, and the clear insulin is drawn up first: clear before cloudy. This sequence prevents contaminating the fast-acting regular insulin vial with the protamine-containing NPH suspension, which would alter its onset. Long-acting analogs such as glargine and detemir are never mixed with any other insulin.