Comprehensive Nursing Pharmacology Q 14
A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should:
A. Draw up and administer the dose.
B. Shake the vial in an attempt to disperse the clumps.
C. Draw the dose from a new vial.
D. Warm the bottle under running water to dissolve the clump.
Correct Answer: C. Draw the dose from a new vial.
The nurse should always inspect the vial of insulin before use for solution changes that may signify a loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.
Option A: Crystalline NPH insulin administration is subcutaneous. Administration is not Intramuscular or intravenous. NPH insulin is available in a two-phase solution, which means that apart from NPH, it has a solvent or a rapid-acting insulin solution. It comes in the form of a subcutaneous suspension or suspension pen-injector.
Option B: The abdominal subcutaneous injection causes quicker absorption as compared to arms or thighs. The most significant advantage of NPH is that it can be included in premixed formulation with regular insulin. NPH in premixed formulations does not affect the potency and time-action profile of regular insulin. Exercise, massage, and local heat application increase NPH insulin absorption.
Option D: NPH insulin has a somewhat higher risk of hypoglycemia. Inadequate resuspension is thought to contribute to the high day to day variability in the pharmacodynamic and pharmacokinetic profile of NPH insulin, leading to hypoglycemia. Patients can adequately resuspend NPH by rotating the vial several times until it’s uniformly cloudy.