The nurse prepares to draw up regular and NPH insulins into one syringe. Place in order the steps the nurse should take when mixing the insulins. All options must be used. A)Clean the vial tops with alcohol swabs B)Draw up the NPH insulin solution C)Draw up the regular insulin solution D)Inject air into the NPH insulin vial E)Inject air into the regular insulin vial

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11ecbb05_cb80_f73a_b433_2f55bcda70ac_MD0009_00 Mixing insulins allows multiple insulin preparations to be delivered in a single subcutaneous injection, thereby sparing the client from multiple injections. Intermediate-acting insulins (eg, NPH) can be mixed with short-acting (eg, regular) or rapid-acting (eg, aspart, lispro) insulins. Most long-acting insulins (eg, glargine, detemir) are not suitable for mixing and are typically packaged in prefilled syringes. When drawing up multiple insulins, there is a risk for contaminating the shorter-acting vials with the longer-acting insulin, which would slow the action of later doses withdrawn from the shorter-acting insulin vial. Multidose vials of regular insulin that have been contaminated with other insulins are unsafe for IV administration. When drawing up multiple insulins, the nurse should: Clean both vial tops with alcohol swabs (Option A). Inject air into the NPH insulin vial without touching the needle to the solution (Option D). Withdraw the needle from the NPH insulin vial and inject air into the regular insulin vial (Option E). Invert the regular vial and withdraw the regular solution into the syringe (Option C). Insert the needle into the NPH insulin vial and withdraw the solution (Option B). The nurse can recall the mnemonic RN (Regular before NPH). Educational objective: When drawing up multiple insulins, there is a risk for contaminating the shorter-acting insulin vial with longer-acting insulin and slowing the action of later doses withdrawn from the shorter-acting insulin vial. The nurse should withdraw the shorter-acting insulin first, and then use the same syringe to withdraw the intermediate-acting insulin.

The Nurse Prepares to Draw Up Regular and NPH Insulins