The nurse instructs the client on mixing NPH and regular insulin in the same syringe. Rank the client teaching in the order the client should follow to ensure accurate dosing

Question

1. Withdraw the NPH insulin.
2. Withdraw the regular insulin.
3. Remove air bubbles for correct dose.
4. Calculate the combined total volume of insulin.
5. Inject air equal to the NPH insulin volume into the vial.
6. Inject air equal to the regular insulin volume into the vial.

Answer 1

5, 6, 2, 3, 4, 1
3. The first step for the client when mixing NPH and regular insulin is to aspirate air into the syringe equal to the volume of NPH insulin needed, inject the air into the NPH vial and avoid removing NPH insulin at this time. Injecting the air prepares the vial to dispense the correct volume of NPH insulin by displacement.
6 and 2. The nurse instructs the client to perform the same actions on the regular in-sulin with the same syringe, making sure the correct volume is aspirated and injected into the vial; then the client withdraws the correct volume of regular insulin.
3. The client should remove the air bubbles at this time to ensure the correct dose.
4. The nurse double checks the MAR and the prescription and calculates the total volume of the combined insulins.
1. Finally, the client inserts the needle into the NPH vial, allows the insulin to flow into the syringe containing the regular insulin, and matches unit measurements on the syringe to ensure the correct dose.