Administration Technique Flashcards

A QMA is preparing to administer insulin using an insulin pen for the first time on a resident. After attaching a new needle, what is the immediate next step to ensure the pen is ready and will deliver an accurate dose?

Answer: Prime the pen by dialing 2 units and pressing the injection button until a drop of insulin appears.

Priming the insulin pen is a critical safety step. It removes any air from the needle and cartridge, ensuring that the resident receives the full, accurate dose of insulin. Shaking an insulin pen is incorrect; cloudy insulins should be gently rolled. Dialing the dose is done after priming, and wiping a new, sterile needle is unnecessary.

When administering a subcutaneous insulin injection, what is the best practice for site rotation to prevent lipohypertrophy?

Answer: Use the same general area, like the abdomen, but inject at least one inch away from the previous spot.

Proper site rotation involves using the same body area (e.g., abdomen, thigh) but moving the specific injection spot for each dose. Injections should be given about one inch, or a finger's width, apart to prevent the buildup of fatty tissue (lipohypertrophy), which can affect insulin absorption. Using the exact same spot repeatedly or only alternating between two large areas without systematic rotation within those areas is incorrect and increases the risk of complications.

A resident's order requires mixing 12 units of NPH (cloudy) insulin and 5 units of Regular (clear) insulin. Which of the following describes the correct procedure for drawing the insulin into the syringe?

Answer: Inject 12 units of air into the NPH vial, then 5 units of air into the Regular vial, then draw up 5 units of Regular, and finally 12 units of NPH.

The correct and safe procedure for mixing insulins is often remembered by the mnemonic "cloudy, clear, clear, cloudy" or "RN" (Regular before NPH). Air is injected into the cloudy (NPH) vial first, then air is injected into the clear (Regular) vial. The clear insulin is then drawn up, followed by the cloudy insulin. This prevents the shorter-acting clear insulin from being contaminated by the longer-acting cloudy insulin.

A QMA is administering insulin with a syringe and needle to an average-sized adult resident in the abdomen. The QMA has gently pinched the skin. At what angle should the needle be inserted?

Answer: 90 degrees

For a subcutaneous injection in an average-sized adult, especially when using modern, shorter needles, a 90-degree angle is the standard technique. This ensures the insulin is delivered into the fatty tissue (subcutaneous layer) below the skin, not into the muscle. A 45-degree angle is typically reserved for very thin individuals or when using a longer needle.

After administering an insulin injection via an insulin pen, what is the correct action the QMA should take before removing the needle from the resident's skin?

Answer: Hold the pen in place and count for up to 10 seconds.

After the injection button is fully depressed, the pen should be held in place for about 10 seconds to ensure the full dose of insulin is delivered and to prevent medication from leaking out of the injection site. Massaging the site is not recommended as it can affect insulin absorption rates. Needles should not be recapped but disposed of in a sharps container.

Which of the following sites has the fastest rate of insulin absorption?

Answer: Abdomen

The abdomen is the preferred site for insulin injections because it provides the most rapid and predictable absorption of insulin compared to other sites like the thigh, buttocks, or arm. The rate of absorption is slowest from the buttocks and thighs.