護理師教導一位新診斷的一型糖尿病病人如何將 NPH 與一般胰島素（Regular insulin）混合在同一個針筒中。下列哪項指導是正確的？
A nurse is teaching a client with newly diagnosed type 1 diabetes about mixing NPH and regular insulin in one syringe. Which instruction is correct?
- ADraw up the NPH insulin before the regular insulin.先抽取 NPH 胰島素，再抽取一般胰島素。
- BShake the NPH vial vigorously before drawing up the dose.抽取劑量前，劇烈搖晃 NPH 胰島素瓶。
- CAlways draw up 0.5 mL of air into the NPH vial last.最後總是向 NPH 瓶注入 0.5 mL 空氣。
- DDraw up the regular insulin before the NPH insulin.✓ 正解先抽取一般胰島素，再抽取 NPH 胰島素。
混合胰島素的正確順序是為了防止長效（NPH）胰島素污染短效（Regular）胰島素的藥瓶。核心原則是「先清後濁（Clear before Cloudy）」。正確答案 D 描述了先抽取透明的一般胰島素，再抽取混濁的 NPH。若先抽 NPH，針頭上殘留的蛋白質（Protamine）可能會進入 Regular 藥瓶內，改變其藥效動力學。此外，NPH 應輕輕滾動而非劇烈搖晃（選項 B 錯誤）。此知識點是護理技術中的基礎，旨在確保藥物純度與預期降血糖效果。臨床思路應依循「保護速效藥物」的原則來執行操作。
The correct sequence for mixing insulins is designed to prevent contamination of the short-acting (regular) insulin vial by the intermediate-acting (NPH) insulin. The core principle is "clear before cloudy." The correct answer, D, describes drawing up the clear regular insulin first and then the cloudy NPH. If NPH is drawn up first, protamine residue from the needle may enter the regular insulin vial, altering its pharmacokinetics. Additionally, NPH should be gently rolled rather than vigorously shaken (option B is incorrect). This knowledge point is fundamental to nursing skills and ensures medication purity and the expected glycemic effect. Clinical reasoning should follow the principle of "protect the rapid-acting medication" when performing this procedure.
美國護理教學非常強調「RN (Regular before NPH)」這個口訣；台灣臨床實務中，由於預混型胰島素（Premixed）的普及，病人自行混合兩種胰島素的情況減少，但此技術仍是考照與臨床必備的基礎知識。