- A 66-year-old client with type 2 diabetes is hospitalized for heart failure exacerbation. Current regimen: insulin glargine 24 units at 2100 and insulin lispro 6 units with meals. Recent readings: 0700 blood glucose 110 mg/dL; 1200 blood glucose 58 mg/dL (normal fasting 70–100 mg/dL) with dizziness and diaphoresis. The lunch tray has arrived and the client is alert. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Give 15 g rapid-acting carbohydrate before the meal and recheck blood glucose in 15 minutes
This question tests the application of insulin management and hypoglycemia intervention in a hospitalized client with type 2 diabetes and heart failure. The priority concern is symptomatic hypoglycemia with blood glucose of 58 mg/dL at mealtime, needing immediate correction before eating. Giving 15 g rapid-acting carbohydrate before the meal and rechecking in 15 minutes best addresses this to safely raise glucose for an alert client. Administering lispro now worsens the low; encouraging full tray intake delays treatment; discontinuing insulin is unsafe. Pre-meal hypoglycemia requires fast-acting intervention. Monitoring ensures resolution before proceeding. A transferable strategy is to treat lows promptly even at mealtimes to maintain safety in insulin regimens.
- A 28-year-old client with type 1 diabetes is seen in an outpatient clinic for insulin education. The regimen is insulin glargine 22 units subcutaneously at bedtime and insulin lispro with meals using carbohydrate counting. Recent self-monitoring shows pre-lunch blood glucose values of 58–65 mg/dL for the last 3 days (expected fasting 70–99 mg/dL), and the client reports mid-day shakiness and sweating. History includes recent increase in exercise during lunch breaks. What teaching point is MOST important for the client regarding insulin administration?
Answer: Carry a fast-acting glucose source at all times and treat symptoms with 15 g carbohydrate, then recheck in 15 minutes
This question tests application of insulin management and hypoglycemia prevention education. The priority concern is teaching proper hypoglycemia recognition and treatment for a patient experiencing recurrent mid-day hypoglycemia related to increased exercise. Teaching to carry fast-acting glucose and use the 15-15 rule (Option B) provides the most important safety information for managing hypoglycemia episodes. Taking insulin lispro 2 hours after eating (Option A) would cause postprandial hyperglycemia; skipping basal insulin on exercise days (Option C) disrupts glucose control and increases ketosis risk; switching to regular insulin (Option D) doesn't address the exercise-induced hypoglycemia pattern. The nursing principle emphasizes that all insulin-dependent patients must understand hypoglycemia treatment protocols and always have rapid-acting glucose available. For effective insulin management, teach patients to adjust carbohydrate intake or insulin doses when increasing physical activity rather than skipping doses.
- A 49-year-old client with type 1 diabetes reports erratic blood glucose levels due to inconsistent meal patterns while working rotating shifts. The regimen is insulin glargine 20 units subcutaneously at bedtime and insulin lispro 1 unit per 10 g carbohydrate with meals. Recent readings show pre-meal values ranging from 65–220 mg/dL; the client describes episodes of sweating and shakiness when meals are delayed, with one reading of 59 mg/dL (expected fasting 70–99 mg/dL). History includes recent weight loss and increased caffeine intake. What teaching point is MOST important for the client regarding insulin administration?
Answer: Plan consistent carbohydrate intake and carry quick sugar; if a meal is delayed, treat symptoms with 15 g carbohydrate and recheck in 15 minutes
This question tests application of insulin management education for patients with erratic schedules. The priority concern is preventing hypoglycemia while maintaining glycemic control despite irregular meal patterns. Teaching to plan consistent carbohydrate intake, carry quick sugar, and use the 15-15 rule for delayed meals (Option B) provides practical strategies for managing unpredictable schedules. Taking lispro without meals (Option A) causes hypoglycemia; doubling glargine when missing meals (Option C) is dangerous; using only sliding-scale insulin (Option D) leads to poor overall control. The nursing principle emphasizes that shift workers need flexible insulin strategies that maintain basal coverage while adjusting bolus doses based on actual intake. For effective insulin management with irregular schedules, teach patients to maintain consistent basal insulin while timing rapid-acting insulin with actual food consumption.
- A 62-year-old client with type 2 diabetes is being discharged after treatment for bronchitis. The client's home regimen is insulin glargine 28 units at bedtime and insulin lispro with meals. The client reports several bedtime blood glucose readings of 72–78 mg/dL (normal fasting 70–100 mg/dL) and one episode of nocturnal sweating with a reading of 64 mg/dL. Relevant history: lives alone. What teaching point is MOST important for the client regarding insulin administration?
Answer: Keep glucose tablets at the bedside and treat blood glucose under 70 mg/dL using the 15-15 rule
The key teaching is to prepare for nocturnal hypoglycemia, especially because the client lives alone. A reading of 64 mg/dL with sweating means the client needs a fast-acting carbohydrate at the bedside and a clear response: for blood glucose under 70 mg/dL, use the 15-15 rule—15 g of carbohydrate, wait 15 minutes, and recheck. Taking extra insulin glargine when sweaty would worsen the low, since glargine is long-acting basal insulin, not a rescue dose. Taking lispro at bedtime is also wrong: lispro is rapid-acting mealtime insulin, so it would peak overnight and increase hypoglycemia risk. Stopping nighttime checks removes the detection needed to prevent severe lows; prioritizing sleep over a low reading does not protect the client. The priority is an accessible treatment plan, not changing insulin timing or skipping monitoring.
- A 55-year-old client with type 2 diabetes is in an outpatient clinic for medication review. Current regimen: insulin glargine 32 units at bedtime and insulin lispro 10 units with dinner. The client reports pre-bedtime blood glucose readings of 65–70 mg/dL (normal fasting 70–100 mg/dL) with sweating and reports eating a very light dinner most nights. Relevant history: hypertension. What teaching point is MOST important for the client regarding insulin administration?
Answer: Discuss matching mealtime insulin to carbohydrate intake and treat blood glucose under 70 mg/dL promptly
This client reports pre-bedtime glucose readings of 65–70 mg/dL with sweating — signs of hypoglycemia driven by a lispro dose that is too large for the very light dinners. The most important teaching is to match the mealtime insulin to the carbohydrate actually eaten — a lighter dinner calls for a smaller bolus — and to treat any reading below 70 mg/dL immediately rather than wait for symptoms. Stopping insulin glargine when the bedtime reading is low is incorrect: basal insulin supplies necessary background coverage, and discontinuing it would risk rebound hyperglycemia without fixing why the lows occur. Avoiding bedtime snacks misses the issue because the problem is the mismatch between the lispro dose and the meal, not the snack itself, and skipping snacks does nothing to resolve the current hypoglycemia. Taking lispro 2 hours after dinner is also wrong: lispro is rapid-acting and must be given with or right before the meal to cover the post-dinner glucose rise; delaying it would leave that rise uncovered and would not prevent a bedtime low. Only the option that adjusts mealtime insulin to carbohydrate intake and treats the low promptly addresses this client's reported pattern.
- A 64-year-old client with type 2 diabetes is hospitalized after receiving insulin for hyperglycemia. The client received insulin lispro 8 units subcutaneously at 1200 with lunch and insulin glargine 18 units at 2100. At 1430, the client reports sudden hunger, tremors, and blurred vision; blood glucose is 63 mg/dL (normal fasting 70–100 mg/dL). Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Give 15 g rapid-acting carbohydrate and recheck blood glucose in 15 minutes
Hypoglycemia with symptoms and a glucose of 63 mg/dL requires immediate rapid-acting carbohydrate. The standard first-line intervention is 15 g of rapid-acting carbohydrate, then recheck blood glucose in 15 minutes. Giving a peanut butter and cracker snack is not first because fat and protein delay glucose absorption, so it corrects the low too slowly. Encouraging ambulation is dangerous here: physical activity increases glucose use and can make hypoglycemia worse. Notifying the provider to lower tonight's glargine dose addresses prevention or future dosing, not the current low, and should occur after acute treatment. Therefore, the first action is to give 15 g rapid-acting carbohydrate and recheck the blood glucose in 15 minutes.
- A 56-year-old client with type 2 diabetes is in an outpatient clinic. Current regimen: insulin detemir 14 units at bedtime and insulin aspart 6 units with meals. The client reports several episodes of blood glucose 60–69 mg/dL (normal fasting 70–100 mg/dL) with sweating after taking mealtime insulin and then eating less than planned. Relevant history: recent dental pain limiting intake. What teaching point is MOST important for the client regarding insulin administration?
Answer: Match mealtime insulin to the amount you will eat and keep fast-acting carbohydrates available for lows
Mealtime insulin should be matched to the amount of food the client actually eats. The client's blood glucose is falling after taking a mealtime dose and then eating less than planned, so adjusting the next dose to the planned amount and having fast-acting carbohydrate available for hypoglycemia is the safest teaching point. Delaying treatment until the glucose is below 50 mg/dL is unsafe: low blood glucose with symptoms should be treated promptly, not allowed to become more severe. Moving mealtime insulin to bedtime separates the insulin from the meal it is meant to cover and can cause overnight hypoglycemia. Increasing basal insulin when intake is smaller adds long-acting insulin when less food is available, which can push the glucose even lower. Therefore, the priority is to tailor the mealtime dose to the meal and keep fast-acting carbohydrate available for lows.
- A 70-year-old client with type 2 diabetes is admitted for heart failure exacerbation and is receiving insulin NPH 12 units subcutaneously every morning and insulin regular 4 units subcutaneously before meals. At 1400, the client reports dizziness and hunger; assessment shows diaphoresis and tachycardia. Blood glucose is 60 mg/dL (expected fasting 70–99 mg/dL). History includes coronary artery disease and beta-blocker therapy. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Administer 15 g rapid-acting carbohydrate and recheck blood glucose in 15 minutes
This question tests application of insulin management and hypoglycemia intervention in an elderly cardiac patient. The priority concern is immediate correction of hypoglycemia (60 mg/dL) in a patient experiencing classic symptoms of dizziness, hunger, diaphoresis, and tachycardia. Administering 15 g rapid-acting carbohydrate and rechecking in 15 minutes (Option A) follows the standard 15-15 rule for conscious patients who can swallow. A peanut butter sandwich (Option B) contains protein and fat that delay glucose absorption, making it inappropriate for immediate treatment; obtaining an ECG (Option C) delays urgent treatment; giving more insulin (Option D) would worsen hypoglycemia. Beta-blockers can mask hypoglycemic symptoms like tachycardia, making blood glucose monitoring especially important. The transferable strategy is to always treat symptomatic hypoglycemia immediately with simple carbohydrates before addressing any other concerns.
- A 34-year-old client with type 1 diabetes is hospitalized for a kidney stone. Current regimen: insulin glargine 20 units at bedtime and insulin lispro 5 units with meals. At 1015, the client becomes pale and reports feeling "weak and shaky"; blood glucose is 48 mg/dL (normal fasting 70–100 mg/dL). The client is alert but has vomiting and cannot keep liquids down. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Administer intravenous dextrose per protocol and recheck blood glucose in 15 minutes
This question tests the application of insulin management and hypoglycemia intervention in a hospitalized client with type 1 diabetes and vomiting. The priority concern is severe hypoglycemia with blood glucose of 48 mg/dL and inability to tolerate oral intake, requiring IV treatment. Administering intravenous dextrose per protocol and rechecking in 15 minutes best addresses this for safe, rapid correction. Giving juice risks aspiration; holding glargine is not immediate; deep breathing doesn't treat hypoglycemia. Vomiting necessitates non-oral routes. Protocol adherence ensures timeliness. A transferable strategy is to escalate to IV interventions when oral fails in hypoglycemia management.
- A 34-year-old newly diagnosed client with type 1 diabetes is learning insulin administration. The prescribed regimen is insulin glargine 16 units subcutaneously at bedtime and insulin lispro 5 units subcutaneously with each meal. The client reports one episode of shakiness and sweating yesterday with a home blood glucose of 62 mg/dL (expected fasting 70–99 mg/dL). History includes no other chronic conditions. What teaching point is MOST important for the client regarding insulin administration?
Answer: Administer insulin glargine at the same time each day and do not mix it in the same syringe with other insulins
This question tests application of insulin administration education for a newly diagnosed type 1 diabetic. The priority concern is ensuring safe insulin administration practices to prevent medication errors and hypoglycemia. Teaching to administer insulin glargine at the same time daily without mixing (Option B) is most important because glargine is a long-acting basal insulin that cannot be mixed with other insulins and requires consistent timing. Taking lispro at bedtime (Option A) is incorrect as it's rapid-acting for meals; skipping meals with high glucose (Option C) increases hypoglycemia risk; treating all glucose below 90 mg/dL (Option D) is unnecessary as 70-99 mg/dL is normal. The nursing principle emphasizes that basal insulin provides steady background coverage and must be given consistently regardless of food intake. For effective insulin management, teach patients the distinct roles of basal versus bolus insulin to ensure proper administration.
- A 39-year-old client with type 1 diabetes is in the hospital after appendectomy. The client receives insulin glargine 22 units at bedtime and insulin lispro 4 units with meals. At 0200, the client is difficult to arouse and has a blood glucose of 40 mg/dL (normal fasting 70–100 mg/dL). Relevant history: no seizures; NPO except sips of water. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Administer intravenous dextrose per hypoglycemia protocol and recheck blood glucose in 15 minutes
This question tests the application of insulin management and hypoglycemia intervention in a post-surgical client with type 1 diabetes. The priority concern is severe hypoglycemia with blood glucose of 40 mg/dL and altered arousal, requiring immediate non-oral correction due to safety risks. Administering intravenous dextrose per protocol and rechecking in 15 minutes best addresses this as the client is difficult to arouse and NPO, ensuring rapid glucose delivery. Oral glucose gel risks aspiration; administering glargine worsens hypoglycemia; calling the provider delays treatment when protocols exist. Intravenous routes are vital for unresponsive clients to prevent brain injury. Hypoglycemia protocols guide safe, timely interventions. A transferable strategy is to assess consciousness and swallowing ability before selecting hypoglycemia treatments in insulin-managed clients.
- A 58-year-old client with type 2 diabetes is seen in an outpatient clinic. Current regimen: NPH insulin 14 units at 0700 and 10 units at 1900, plus regular insulin 6 units 30 minutes before breakfast and dinner. The client reports inconsistent meal times due to shift work and has had midafternoon blood glucose readings of 55–65 mg/dL (normal fasting 70–100 mg/dL) with shakiness. What teaching point is MOST important for the client regarding insulin administration?
Answer: Plan a consistent meal schedule and include a midafternoon snack to reduce NPH-related lows
This question tests the application of insulin management and hypoglycemia intervention in a client with type 2 diabetes and inconsistent meals. The priority concern is preventing midafternoon hypoglycemia from NPH insulin peaking, as seen in readings of 55–65 mg/dL with shakiness. Planning a consistent meal schedule with a midafternoon snack best addresses this by aligning intake with NPH's action profile. Taking regular insulin after eating mismatches its onset; doubling evening NPH on skipped lunch days risks overdose; treating under 100 mg/dL with a full meal is excessive. Consistent timing reduces hypoglycemia risk in intermediate-acting insulins. Education on insulin pharmacokinetics aids self-management. A transferable strategy is to synchronize meals and snacks with insulin peaks for stable glucose in regimens using NPH.
- A 23-year-old newly diagnosed client with type 1 diabetes is being taught about insulin. The prescribed regimen is NPH insulin 10 units subcutaneously at 0730 and 1730 and regular insulin 6 units subcutaneously 30 minutes before breakfast and dinner. This morning the client reports feeling anxious with palpitations and has a blood glucose of 60 mg/dL (normal fasting 70–100 mg/dL). Relevant history includes recent weight loss and no other chronic conditions. Which finding indicates that immediate intervention is needed?
Answer: Blood glucose 60 mg/dL with palpitations and anxiety
This question tests the application of insulin management and hypoglycemia intervention in a newly diagnosed client with type 1 diabetes. The priority concern is the immediate risk of harm from hypoglycemia, evidenced by blood glucose of 60 mg/dL with palpitations and anxiety. The finding of blood glucose 60 mg/dL with symptoms indicates that immediate intervention is needed to correct the low glucose and prevent deterioration. Weight loss is expected in new type 1 diabetes but not acute; using NPH twice daily is the regimen but not urgent; planning to inject regular insulin before meals is correct but not the priority. Hypoglycemia requires rapid assessment and treatment to avoid neuroglycopenic effects. Education on insulin timing and monitoring is essential for new users. A transferable strategy is to routinely check blood glucose when symptoms arise and adjust insulin based on patterns to manage regimens effectively.
- A 45-year-old client with type 1 diabetes comes to an outpatient clinic for follow-up. Current regimen: insulin glargine 18 units at bedtime and insulin lispro using a sliding scale before meals. Home readings for the past week show fasting 70–85 mg/dL (normal fasting 70–100 mg/dL) and pre-lunch 55–65 mg/dL with symptoms of tremor and sweating. The client reports no changes in activity and is eating breakfast as usual. What teaching point is MOST important for the client regarding insulin administration?
Answer: Treat any blood glucose under 70 mg/dL with 15 g carbohydrate and recheck in 15 minutes
This question tests the application of insulin management and hypoglycemia intervention in a client with type 1 diabetes experiencing pre-lunch lows. The priority concern is preventing and treating recurrent hypoglycemia, as indicated by pre-lunch blood glucose of 55–65 mg/dL with symptoms. Teaching to treat any blood glucose under 70 mg/dL with 15 g carbohydrate and recheck in 15 minutes is most important as it empowers the client to manage acute episodes safely. Decreasing bedtime glargine only on exercise days does not address daily patterns; taking lispro after eating mismatches its rapid action; skipping breakfast for low fasting glucose risks further instability. Recognizing hypoglycemia symptoms early promotes prompt intervention. Adjusting insulin regimens requires collaboration with providers based on glucose logs. A transferable strategy is to maintain consistent carbohydrate intake and monitor blood glucose before meals to prevent hypoglycemia in insulin therapy.
- A 66-year-old client with type 2 diabetes is in the hospital for a urinary tract infection. The client's insulin regimen includes insulin glargine 26 units subcutaneously at bedtime and insulin lispro 4 units subcutaneously with meals. At 1000, the client is anxious, shaky, and diaphoretic; blood glucose is 44 mg/dL (expected fasting 70–99 mg/dL). The client is awake and able to swallow. History includes mild cognitive impairment. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Administer 15 g rapid-acting carbohydrate orally and recheck blood glucose in 15 minutes
This question tests application of insulin management and hypoglycemia intervention in a hospitalized patient. The priority concern is immediate correction of severe hypoglycemia (44 mg/dL) in a conscious patient who can swallow safely. Administering 15 g rapid-acting carbohydrate orally and rechecking in 15 minutes (Option A) follows the standard first-line treatment protocol for conscious patients. Administering more insulin (Option B) would worsen hypoglycemia; continuous dextrose infusion (Option C) is unnecessary for a conscious patient who can take oral treatment; teaching about injection sites (Option D) doesn't address the immediate crisis. The nursing principle emphasizes rapid intervention for symptomatic hypoglycemia while considering the patient's ability to safely take oral carbohydrates. For effective hypoglycemia management, always use the least invasive effective intervention - oral treatment for conscious patients, parenteral for those with altered mental status.
- A 45-year-old client with type 1 diabetes is in the hospital after an appendectomy. The insulin regimen is insulin glargine 18 units subcutaneously at bedtime and insulin lispro per correction scale before meals. Recent readings: 0700 blood glucose 118 mg/dL; 1100 blood glucose 72 mg/dL; at 1130 the client is confused, pale, and trembling; blood glucose is 48 mg/dL (expected fasting 70–99 mg/dL). History includes gastroparesis. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Administer 25 g dextrose intravenously per protocol because the client has altered mental status
This question tests application of insulin management and hypoglycemia intervention in a post-surgical patient with altered mental status. The priority concern is immediate correction of severe hypoglycemia (48 mg/dL) in a confused patient who may not be able to safely swallow. Administering 25 g dextrose intravenously (Option B) is the correct intervention because the patient's confusion indicates altered mental status, making oral treatment unsafe. Administering insulin glargine early (Option A) would not treat the current hypoglycemia; encouraging oral intake (Option C) is unsafe with altered mental status and gastroparesis; discontinuing all insulin (Option D) addresses future management but not the immediate crisis. The nursing principle here is that patients with altered mental status require parenteral glucose administration to avoid aspiration risk. For effective insulin management, always assess the patient's level of consciousness before choosing between oral and parenteral glucose replacement.
- A 52-year-old client with type 2 diabetes is in an outpatient clinic for follow-up. The current insulin regimen is insulin NPH 10 units subcutaneously at 0700 and 10 units at 1900, plus insulin regular 5 units subcutaneously 30 minutes before breakfast and dinner. The client reports waking at night with sweating and palpitations; a 0300 blood glucose check was 54 mg/dL (expected fasting 70–99 mg/dL). History includes recent decreased evening food intake to lose weight. The nurse should QUESTION which part of the client's insulin regimen?
Answer: The evening NPH dose timing because its peak can occur overnight and contribute to nocturnal hypoglycemia
This question tests application of insulin regimen analysis for nocturnal hypoglycemia patterns. The priority concern is identifying the cause of nighttime hypoglycemia (54 mg/dL at 0300) with classic symptoms. Questioning the evening NPH dose timing (Option A) is correct because NPH given at 1900 peaks during sleep (2-4 AM), causing nocturnal hypoglycemia, especially with decreased evening food intake. Regular insulin timing before meals (Option B) is correct at 30 minutes; bedtime glucose monitoring (Option C) is appropriate; injection site cleaning (Option D) is acceptable practice. The nursing principle recognizes that evening NPH doses frequently cause overnight hypoglycemia due to peak action during sleep when counter-regulatory responses are diminished. For effective insulin management, consider switching evening NPH to bedtime or using a peakless basal insulin to reduce nocturnal hypoglycemia risk.
- A 68-year-old client with type 2 diabetes is hospitalized for pneumonia. The client receives insulin glargine 20 units subcutaneously at 2100 and insulin lispro 6 units subcutaneously with meals. At 1130, the client is diaphoretic and shaky; blood glucose is 52 mg/dL (normal fasting 70–100 mg/dL). Vital signs: T 98.4°F (36.9°C), HR 108/min, RR 20/min, BP 138/78 mm Hg, SpO2 95% on room air. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Give 15 g of rapid-acting carbohydrate (eg, 4 oz juice) and recheck blood glucose in 15 minutes
The correct first action is to treat the low glucose immediately with oral rapid-acting carbohydrate. This client has symptomatic hypoglycemia and no indication that oral intake is unsafe, so giving 15 g of rapid-acting carbohydrate (e.g., 4 oz juice) and rechecking the glucose in 15 minutes is the priority. Starting an insulin infusion would worsen the low glucose by moving glucose into cells and delays correction. Glucagon is reserved for severe hypoglycemia with altered consciousness or inability to take oral carbohydrate; it is not first-line for an awake, symptomatic client. Holding the next dose of glargine and notifying the provider may be a reasonable follow-up to prevent recurrent hypoglycemia, but it does not raise the current blood glucose and therefore is not the first action. Rechecking after oral glucose guides further treatment.
- A 27-year-old client with type 1 diabetes is admitted for gastroenteritis with poor oral intake. Home regimen: NPH insulin 12 units at 0700 and 12 units at 1900, regular insulin 5 units before meals. On the unit at 1700, the client is pale and trembling; blood glucose is 49 mg/dL (normal fasting 70–100 mg/dL). The client is alert but nauseated and states they cannot tolerate juice. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Administer intravenous dextrose per protocol and recheck blood glucose in 15 minutes
This question tests the application of insulin management and hypoglycemia intervention in a client with type 1 diabetes and poor intake. The priority concern is severe hypoglycemia with blood glucose of 49 mg/dL and nausea preventing oral intake, requiring non-oral treatment. Administering intravenous dextrose per protocol and rechecking in 15 minutes best addresses this for rapid correction in an alert but nauseated client. Encouraging milk risks vomiting; giving NPH worsens the low; notifying before treating delays care. IV dextrose is essential when oral routes fail. Dehydration from gastroenteritis exacerbates instability. A transferable strategy is to use protocols for alternative routes in hypoglycemia when oral intake is compromised.
- A 62-year-old client with type 2 diabetes is hospitalized for pneumonia. The client's current insulin regimen is insulin glargine 20 units subcutaneously at bedtime and insulin lispro 6 units subcutaneously with meals. One hour after receiving insulin lispro for lunch, the client reports shakiness and diaphoresis; blood glucose is 52 mg/dL (expected fasting 70–99 mg/dL). Medical history includes chronic kidney disease stage 3 and hypertension. Which action should the nurse take FIRST in response to the client's hypoglycemia?
Answer: Administer 15 g of rapid-acting carbohydrate (eg, 4 oz juice) and recheck blood glucose in 15 minutes.
For a blood glucose of 52 mg/dL with shakiness and diaphoresis, the client has hypoglycemia. The nurse should give 15 g of rapid-acting carbohydrate, such as 4 oz of juice, and recheck the blood glucose in 15 minutes; this is the first-line response for a conscious client who can swallow safely. Holding the next 20 units of insulin glargine and notifying the provider is a later or preventive action; it does not raise the current blood glucose. Administering glucagon and placing the client in a high-Fowler position to protect the airway is not the first response because this client is conscious and able to take oral carbohydrate. Starting an intravenous infusion of regular insulin would lower the blood glucose further and is contraindicated in hypoglycemia. After the glucose is corrected, the nurse can reassess insulin needs and notify the provider, but treating the hypoglycemia is the immediate priority.
