A nurse is preparing regular and NPH insulin in the same syringe for a client who has diabetes mellitus.
Which of the following actions should the nurse take?
Administer the mixture within 5 minutes of preparing it.
Inject air into the regular insulin vial before injecting air into the NPH vial.
Withdraw the NPH insulin before the regular insulin.
Shake both insulin vials for 2 minutes before withdrawing the doses.
The Correct Answer is A
Choice A rationale
Regular insulin is a rapid-acting insulin, and NPH is an intermediate-acting insulin. When mixed in the same syringe, the regular insulin molecules can bind to the protamine in the NPH suspension. This can alter the absorption profile of the regular insulin, delaying its onset of action. Administering the mixture within 5 minutes prevents this molecular interaction and ensures the regular insulin retains its rapid-acting properties.
Choice B rationale
It is crucial to inject air into the NPH insulin vial first, followed by the regular insulin vial, and then withdraw the regular insulin dose before the NPH. This specific order prevents the NPH from contaminating the regular insulin vial with protamine, which would alter the potency and action profile of the regular insulin for future use. The regular insulin is then drawn up first.
Choice C rationale
The correct procedure is to withdraw the regular insulin before the NPH insulin. The sequence is to inject air into both vials, then draw up the clear, rapid-acting regular insulin first, followed by the cloudy, intermediate-acting NPH insulin. This sequence is essential to prevent contamination of the regular insulin vial with the NPH insulin, which could affect its rapid-acting properties.
Choice D rationale
Shaking insulin vials is generally discouraged as it can lead to the formation of air bubbles, which can result in an inaccurate dose. Instead of shaking, the NPH insulin vial should be gently rolled between the palms of the hands. This action warms the insulin and resuspends the particles uniformly without causing bubbles, ensuring an accurate and consistent dose is administered. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
An acute hemolytic transfusion reaction is a severe and life-threatening reaction caused by an incompatibility between the donor's blood and the client's blood. The recipient's antibodies attack and destroy the transfused red blood cells, leading to hemolysis. The classic symptoms include chills, fever, low-back pain, tightness in the chest, and headache. This reaction is a medical emergency requiring immediate cessation of the transfusion and supportive care.
Choice B rationale
An allergic reaction to a blood transfusion is typically caused by the recipient's antibodies reacting to a foreign plasma protein in the donor blood. Symptoms can range from mild, such as hives and itching, to severe, such as anaphylaxis. However, symptoms like low-back pain and a feeling of "tightness" in the chest are more characteristic of a hemolytic reaction rather than a simple allergic response.
Choice C rationale
A febrile nonhemolytic transfusion reaction is the most common type of transfusion reaction. It is caused by the recipient's antibodies reacting to donor white blood cells. Symptoms include fever and chills, but typically do not include the severe manifestations of low-back pain, headache, and chest tightness that are seen in a hemolytic reaction. The reaction is usually not life-threatening.
Choice D rationale
Transfusion-related acute lung injury (TRALI) is a serious and potentially fatal complication of a transfusion. It is characterized by the sudden onset of non-cardiogenic pulmonary edema within six hours of a transfusion. Symptoms primarily involve respiratory distress, such as dyspnea and hypoxemia. While TRALI is severe, the symptoms presented, particularly the low-back pain and chest tightness, are more indicative of an acute hemolytic reaction. .
Correct Answer is B
Explanation
Choice A rationale
Cranberry juice has a low pH, creating an acidic environment in the gastrointestinal tract which can help to neutralize bacteria and reduce malodorous compounds like indole and skatole, thereby decreasing odor. This action is beneficial, so avoiding it is not the correct advice for odor control.
Choice B rationale
Breath mints or commercial deodorizers contain ingredients like peppermint or chlorophyll that chemically neutralize odor-causing volatile sulfur compounds produced during digestion. Placing a breath mint inside the ostomy pouch releases these agents, effectively masking and reducing the unpleasant smell from gas and stool.
Choice C rationale
Eggs are a rich source of sulfur-containing amino acids, such as cysteine and methionine. When these are digested by intestinal bacteria, they produce hydrogen sulfide gas, which is the primary contributor to a strong, unpleasant odor and increased flatus. Consuming eggs would exacerbate the problem.
Choice D rationale
Sugar-free gum often contains sugar alcohols like sorbitol or xylitol. These are poorly absorbed in the small intestine and are fermented by colonic bacteria, leading to the production of gas. This can increase flatus and may contribute to bloating and discomfort for the client.
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