A nurse is caring for a client prescribed Heparin. Which nur… | MyMerci
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Medication AdministrationPPT
Question
A nurse is caring for a client prescribed Heparin. Which nursing action is most appropriate regarding monitoring aPTT levels and preparing protamine sulfate as an antidote?
1Inject the glargine into the subcutaneous tissue first, leave the needle in place for 15 seconds to allow the glargine to form microprecipitates, then inject the regular insulin into the same site to prevent mixing in the syringe, which would alter the insulins' action.
2Administer glargine and regular as TWO separate subcutaneous injections in different sites — long-acting insulins (glargine, detemir, degludec) must NEVER be mixed in the same syringe with any other insulin because mixing changes the absorption profile.
3Inject air equal to the glargine dose into the glargine vial, then air equal to the regular dose into the regular vial; withdraw the regular insulin first, then withdraw the glargine after gently rolling the vial to resuspend the precipitate, then inject subcutaneously.
4Draw up the clear regular insulin first, then the clear glargine into the same syringe, and administer the mixed dose promptly to avoid precipitation, as both insulins are clear and short-acting regular insulin does not alter the long-acting profile of glargine.✓ Correct answer
Explanation
When administering Heparin, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
Clinical reasoning summary Mixing rule for insulin The cardinal rule: long-acting basal insulins (glargine, detemir, degludec) must NEVER be mixed in the same syringe with any other insulin. Mixing changes the pH and crystalline structure, altering absorption and unpredictably reducing both drugs effects.
What CAN be mixed: • Regular + NPH: yes — proper sequence is air-into-NPH, air-into-regular, draw regular first then NPH (Clear-before-cloudy). Inject within 5-15 minutes (some sources say within 1 hour). • Rapid + NPH (lispro/aspart + NPH): yes — many premixed products exist (Humalog Mix 75/25, Novolog Mix 70/30).
What must NOT be mixed: • Glargine (Lantus, Toujeo): pH 4 — clear acid solution; mixing precipitates other insulins. • Detemir (Levemir). • Degludec (Tresiba). • U-500 regular (concentrated; never mix; high-alert).
Standard practice: use SEPARATE syringes and inject in different sites (still rotate). Document each separately.
Skipping regular insulin (option 4) is unsafe — regular covers prandial glucose; glargine covers basal. They are not interchangeable.