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 ["B"]
Explanation
Choice A rationale
A dosimeter is used to measure the amount of radiation exposure for the healthcare professional, not the client. It is a personal radiation-monitoring device that provides a record of an individual's accumulated dose of ionizing radiation. Attaching a dosimeter to the client's gown is an inappropriate intervention as the client is the source of the radiation, and the dosimeter is designed to protect the healthcare worker by monitoring their exposure.
Choice B rationale
Brachytherapy involves placing a radioactive source close to the tumor. To minimize the radiation exposure of others, a safe distance is maintained. A distance of at least 1 meter (3.3 feet) from the source of radiation is a standard safety measure for visitors and healthcare staff. This inverse square law principle of radiation safety dictates that intensity decreases with the square of the distance from the source, so increasing distance significantly reduces exposure.
Choice C rationale
When a client is undergoing brachytherapy, it is essential to limit the amount of time visitors spend in close proximity. The typical time limit for visitors is 30 minutes per day, not 2 hours. This is a crucial radiation safety measure that adheres to the principle of "Time, Distance, and Shielding.”. Limiting the time of exposure directly reduces the total radiation dose received by the visitor, thereby minimizing potential harm from the radiation source.
Choice D rationale
For a client undergoing brachytherapy, there is a risk that the radioactive implant could be dislodged and expelled from the body. Therefore, straining the client's urine is a critical intervention. This allows the nurse to inspect for and retrieve the implant if it has been inadvertently expelled, ensuring it is not lost and that appropriate safety protocols for handling radioactive materials are followed. This also prevents potential radiation exposure to others. *.
Correct Answer is A
Explanation
Choice A rationale
Measuring the client's legs with a tape measure is the correct action to ensure proper sizing of the antiembolic stockings. Correct sizing is critical for effective venous compression and to prevent complications such as skin irritation, tissue damage, or impaired circulation. Stockings that are too tight can act as a tourniquet, while those that are too loose will not provide the necessary graduated compression to facilitate venous return and prevent blood stasis, which is the underlying cause of deep-vein thrombosis. This precise measurement ensures the stockings fit snugly and provide optimal therapeutic benefit.
Choice B rationale
Removing the stockings every 24 hours is an insufficient interval for skin integrity checks and to allow for proper cleaning and assessment. The standard practice involves removing antiembolic stockings at least twice daily for a short period. This allows the nurse to inspect the client's skin for any signs of pressure, irritation, or breakdown, and to perform hygiene. Prolonged, continuous wear without breaks can compromise skin integrity and increase the risk of developing pressure injuries, especially in a client who is less mobile due to their condition.
Choice C rationale
Folding the stockings at the top is a harmful and dangerous practice. Folding creates a constrictive band around the client's leg, which acts as a tourniquet. This constriction impedes venous and lymphatic return, leading to increased risk of blood stasis, edema, and tissue damage. The pressure from the folded band can severely compromise circulation and potentially worsen the client's underlying deep-vein thrombosis. The stockings should be smooth and wrinkle-free to provide uniform graduated compression.
Choice D rationale
Massaging the legs of a client with deep-vein thrombosis (DVT) is contraindicated and can be extremely dangerous. Massaging can dislodge the thrombus (blood clot) from the venous wall. If the clot becomes dislodged, it can travel through the bloodstream, leading to a pulmonary embolism (PE), a life-threatening condition where the clot obstructs a pulmonary artery in the lungs. Therefore, any form of massage or direct pressure on the affected limb is strictly avoided to prevent this potentially fatal complication. *.
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