The nurse instructs the client in mixing and administering regular and NPH insulin

The nurse instructs the client in mixing and administering regular and NPH insulin. Which of the following statements indicates that the client needs additional instruction?

1. “I draw up the regular insulin first.”
2. “I shake the bottle of NPH insulin before drawing it up.”
3. “I store the insulin in a cool place.”
4. “I insert the needle at a 90-degree angle.”

The correct answer and explanation is:

Correct Answer: 2. “I shake the bottle of NPH insulin before drawing it up.”

Explanation:

Clients mixing and administering insulin must be properly educated about the correct handling and administration techniques to ensure safe and effective treatment. Here’s a detailed explanation for each statement:

1. “I draw up the regular insulin first.”
   This statement is correct. When mixing regular (clear) insulin and NPH (cloudy) insulin in the same syringe, the regular insulin should always be drawn up first. This prevents contaminating the regular insulin vial with NPH insulin, which could affect the potency and effectiveness of the regular insulin.
2. “I shake the bottle of NPH insulin before drawing it up.”
   This statement is incorrect and indicates the client needs additional instruction. NPH insulin is a suspension and needs to be gently rolled between the palms of the hands to mix it evenly. Shaking the vial can create air bubbles, which may lead to inaccurate dosing. Additionally, vigorous shaking can damage the insulin molecules, reducing its effectiveness.
3. “I store the insulin in a cool place.”
   This statement is correct. Insulin should be stored in a refrigerator or a cool place to maintain its potency. However, it should not be frozen or exposed to extreme heat, as this can degrade the insulin.
4. “I insert the needle at a 90-degree angle.”
   This statement is correct for most clients, especially those with adequate subcutaneous fat. For very thin clients, a 45-degree angle may be used to ensure the insulin is injected into subcutaneous tissue rather than muscle.

Conclusion: Shaking the NPH insulin vial is a critical error as it can compromise the effectiveness of the insulin and lead to dosing inaccuracies. Educating the client on gently rolling the vial instead of shaking it is essential to ensure safe and proper insulin administration.