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?

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. .

Choice A rationale

Rewrapping the bandage every 8 hours is too infrequent. The residual limb bandage should be checked and rewrapped more frequently to ensure continuous, even compression and to prevent the bandage from slipping, which can cause skin irritation or tourniquet effects. The correct application should be in a figure-eight pattern.

Choice B rationale

A client who has undergone a below-the-knee amputation should be turned more frequently than every 4 hours to prevent pressure ulcers and contractures. Turning every 2 hours is the standard of care for a bedridden client. Prolonged pressure on the surgical site can compromise circulation and healing.

Choice C rationale

A trapeze can be a useful tool for clients with lower limb weakness, but for a client post-amputation, excessive upper body strength exertion with the trapeze can cause a compensatory increase in muscle tone and pressure on the stump, which may compromise healing. The focus is to support the residual limb, not to put strain on it.

Choice D rationale

An air mattress, also known as a low-air-loss mattress, is designed to reduce and redistribute pressure evenly across the body's surface. This is particularly important for a client with an amputation to prevent pressure ulcers, promote circulation, and protect the residual limb's surgical incision from excessive pressure, which aids in healing