A nurse is caring for an infant who just had a circumcision. Which of the following actions should the nurse take?

A. Withdraw dose of regular insulin: Withdrawing the regular insulin dose is performed after the air has been injected into both vials and the NPH insulin has been drawn up if using the “clear before cloudy” technique. Doing this first would risk disrupting the proper sequence and potentially contaminating the insulin.

B. Inject air into the vial of regular insulin: Air must be injected into the regular insulin vial before withdrawing the medication, but this step is performed after first injecting air into the NPH vial according to the standard procedure for mixing insulins. Starting with the regular insulin vial would not follow the recommended order.

C. Inject air into the vial of NPH insulin: Injecting air into the NPH insulin vial first is the initial step when preparing a mixed insulin dose. This step equalizes pressure inside the vial, allowing for easier withdrawal later, and follows the correct sequence of “air into cloudy first, then clear,” which prevents contamination of the regular insulin.

D. Withdraw dose of NPH insulin: Withdrawing NPH insulin is done after the regular insulin has been drawn into the syringe to maintain the correct “clear before cloudy” technique. Doing this first could result in accidental mixing or contamination of the regular insulin.

A. Abdomen: The abdomen is typically used for subcutaneous injections, such as insulin or heparin, due to its fatty tissue. It is not ideal for intradermal injections, which require a thin layer of skin to allow for proper absorption and observation of a wheal.

B. Deltoid: The deltoid muscle is commonly used for intramuscular injections, not intradermal ones. Using this site for intradermal injections could result in the medication being deposited too deeply, affecting absorption and test accuracy.

C. Back of the upper arm: The inner surface of the forearm or the back of the upper arm is the preferred site for intradermal injections, such as tuberculosis or allergy testing. This area has thin skin, minimal subcutaneous fat, and allows for easy visualization of the wheal and monitoring for reactions.

D. Upper back: While the upper back has subcutaneous tissue, it is not commonly used for intradermal injections because it is less accessible for observation and assessment of local reactions. Proper site selection is important for safety and effectiveness.