This is an NCLEX practice question on sequencing a nursing procedure. This question provides a scenario about needing to mix short-acting insulin with intermediate-acting insulin and requires you to put those step in the correct order.
This question is one of the many questions we will be practicing in our new series called “Weekly NCLEX Question”.
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NCLEX Drag and Drop Practice Question
The physician orders 10 units of Humulin-R and 12 units of Humulin-N subcutaneously before breakfast daily. You are required to mix these two medications in one syringe for administration. Correctly put in order the steps for how you will perform this procedure:
- Withdraw 10 units of Humulin-R
- Clean off each vial top with alcohol prep
- Don gloves
- Inject 10 units of air into the vial of Humulin-R
- Withdraw 12 units of Humulin-N to equal a total of 22 units in the syringe
- Roll the vial of Humulin-N in between the palms of the hands
- Inject 12 units of air into the vial of Humulin-N
- Wash hands
The best way to answer this type of drag and drop question is to imagine how exactly you would perform this skill step-by-step. If you can see these steps in action in your head it makes sequencing these options easier.
So, what does the question want you to do? It requires you to mix short-acting insulin (Humulin-R…includes regular insulin) with intermediate-acting insulin (Humulin-N….NPH) into ONE syringe so it can be administered to a patient (hence saving a patient from receiving two injections).
To sequence these steps in order, you must ask yourself the following questions:
- What does a nurse ALWAYS perform BEFORE starting a procedure?
- What prep work is involved when drawing up insulin?
- What type of insulin is drawn up first? Clear to Cloudy! Regular Insulin (Humulin-R) and then the NPH (Humulin-N)
Before a nurse performs any type of procedure or has patient contact, hand hygiene must be performed along with donning gloves (if required).
Therefore, the order will look like:
8, 3
What’s left: 1, 2, 4, 5, 6, 7
Now, to the part that requires analyzation of the steps. The next several steps will include the “prep work” that needs to be performed before the actual withdraw of the two types of insulin into one syringe.
Think about what Humulin-N looks like…..it is a cloudy solution. This solution needs to be mixed well before drawing it up. Why? The contents in the vial settles overtime.
The nurse will need to roll the vial of Humulin-N in between the palms of the hands to mix it.
And then the nurse will clean off each vial top with alcohol prep.
Sequence we have so far: 8, 3, 6, 2
What’s left: 1, 4, 5, 7
The next “prep work” steps are to pressurize each vial of insulin. This will be achieved by injecting air into the vial. How much air will you inject? The amount of insulin that is ordered.
The cloudy (Humulin-N) vial will be prepped first by injecting 12 units of air into the vial. You will be prepping the cloudy first because you will be withdrawing it last.
Remember when mixing insulin in a syringe you will draw up from CLEAR to CLOUDY. Also, remembered as RN (Regular to NPH). WHY? It prevents contaminating the vial of clear insulin with the cloudy insulin because if contaminated it can affect the action of the insulin.
Why does this matter because they will be mixed in the syringe? You have 5 to 10 minutes to give the insulin mixed in the syringe before the action of the insulin are affected.
Sequence we have so far: 8, 3, 6, 2, 7
What’s left: 1, 4, 5
Now, it is time to pressurize the clear vial (Humulin-R) by injecting 10 units of air into the vial. After this the needle will be kept inside the vial and the vial will be inverted so the nurse can withdraw 10 units of Humulin-R from the vial.
Sequence we have so far: 8, 3, 6, 2, 7, 4, 1
What’s left: 5
Then the 12 units of Humulin-N will be withdrawn…. adding a total of 22 units in the syringe to equal the dose ordered.
Answer:
8, 3, 6, 2, 7, 4, 1, 5
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