一位第一型糖尿病病人被開立了 10 單位清澈型（Regular）胰島素與 20 單位中效型（NPH）胰島素。在同一支針筒混合這兩種胰島素時，護理師應先採取哪項行動？
A client with type 1 diabetes mellitus is prescribed 10 units of Regular insulin and 20 units of NPH insulin. When mixing these in one syringe, which action should the nurse take first?
- AInject 20 units of air into the NPH vial✓ 正解向 NPH 藥瓶中注入 20 單位空氣
- BInject 10 units of air into the Regular vial向 Regular 藥瓶中注入 10 單位空氣
- CDraw up the NPH insulin into the syringe first先將 NPH 胰島素抽入針筒
- DDraw up the Regular insulin into the syringe first先將 Regular 胰島素抽入針筒
胰島素混合的步驟遵循『空氣先濁後清，抽藥先清後濁』的原則（Clear before Cloudy）。第一步必須先在 NPH（濁）瓶內注入等量的空氣（在此為 20 單位），此時針頭不可接觸到藥液。接著在 Regular（清）瓶注入 10 單位空氣，並直接抽吸藥液。之所以要『先清後濁』是為了防止 NPH 中的蛋白質或添加劑污染 Regular 胰島素瓶，進而改變清澈胰島素的藥代動力學。這題考驗的是操作細節的優先順序。雖然 D（先抽 Regular）是抽藥階段的第一步，但在『整體混合流程』中，必須先完成 NPH 的空氣注入以建立瓶內壓力平衡。
Insulin mixing follows the principle "air into cloudy first, then clear; draw clear before cloudy." The first step is to inject an equal amount of air into the NPH (cloudy) vial (20 units in this case), without letting the needle touch the solution. Next, inject 10 units of air into the Regular (clear) vial and draw up the dose. "Clear before cloudy" prevents NPH proteins and additives from contaminating the Regular insulin vial and altering the pharmacokinetics of the clear insulin. This question tests the priority of procedural detail. Although D (drawing up Regular first) is the first step of the actual withdrawal phase, in the overall mixing procedure the air must first be injected into the NPH vial to establish pressure balance.
在美國，預混胰島素（Premixed）或胰島素筆（Insulin Pens）的使用極為普遍，但在 NCLEX 仍強調手動混合的無菌與正確性。台灣臨床也多用筆型，但護理教育中手動混合仍是技術考點的必考題。