Nclexrn Quiz: Insulin Regimens And Hypoglycemia Management
20 questions · exam conditions
0:00
Insulin Regimens And Hypoglycemia ManagementQuestion 1 of 20

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?

The evening NPH dose timing because its peak can occur overnight and contribute to nocturnal hypoglycemia
The use of insulin regular 30 minutes before meals because it should be given immediately after meals
The recommendation to check blood glucose at bedtime when adjusting insulin
The practice of cleaning the injection site with mild soap and water
← Back to quizzes

Nclexrn Quiz

Nclexrn Quiz: Insulin Regimens And Hypoglycemia Management

Practice Insulin Regimens And Hypoglycemia Management in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Insulin Regimens And Hypoglycemia Management, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

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?

  1. The evening NPH dose timing because its peak can occur overnight and contribute to nocturnal hypoglycemia (correct answer)
  2. The use of insulin regular 30 minutes before meals because it should be given immediately after meals
  3. The recommendation to check blood glucose at bedtime when adjusting insulin
  4. The practice of cleaning the injection site with mild soap and water

Explanation: 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.

Question 2

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?

  1. Take insulin lispro 2 hours after eating to reduce the risk of hypoglycemia
  2. Carry a fast-acting glucose source at all times and treat symptoms with 15 g carbohydrate, then recheck in 15 minutes (correct answer)
  3. Skip insulin glargine on days you plan to exercise at lunchtime
  4. Use regular insulin instead of insulin lispro because it lasts longer

Explanation: 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.

Question 3

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?

  1. Administer 15 g of rapid-acting carbohydrate (eg, 4 oz juice) and recheck blood glucose in 15 minutes (correct answer)
  2. Hold the next scheduled dose of insulin glargine and notify the provider
  3. Administer 1 mg glucagon intramuscularly and place the client in high-Fowler position
  4. Start an intravenous infusion of regular insulin per sliding-scale protocol

Explanation: This question tests application of insulin management and hypoglycemia intervention in a hospitalized diabetic patient. The priority concern is immediate correction of hypoglycemia with a blood glucose of 52 mg/dL, which requires rapid intervention to prevent neurological complications. Administering 15 g of rapid-acting carbohydrate orally and rechecking in 15 minutes (Option A) is the correct first-line treatment for conscious patients who can swallow safely. Holding insulin glargine (Option B) addresses future prevention but not the immediate crisis; glucagon (Option C) is reserved for patients unable to take oral carbohydrates or unconscious patients; and IV insulin (Option D) would worsen hypoglycemia and is contraindicated. The 15-15 rule is the standard nursing intervention for hypoglycemia: give 15 g carbohydrate, wait 15 minutes, and recheck blood glucose. For NCLEX success, remember that immediate treatment of symptomatic hypoglycemia always takes priority over adjusting future insulin doses.

Question 4

A 48-year-old client with type 2 diabetes is admitted for pancreatitis and is on a clear liquid diet. Current regimen: NPH insulin 12 units at 0700 and regular insulin 4 units at 0630. At 1000, the client is diaphoretic with tremors; blood glucose is 57 mg/dL (normal fasting 70–100 mg/dL). The client is alert and able to swallow. Which action should the nurse take FIRST in response to the client's hypoglycemia?

  1. Give 15 g rapid-acting carbohydrate (eg, clear juice) and recheck blood glucose in 15 minutes (correct answer)
  2. Notify the provider to discontinue the clear liquid diet
  3. Provide a high-fat snack to slow glucose absorption
  4. Administer the next dose of NPH insulin early to prevent hyperglycemia

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a client with type 2 diabetes on a liquid diet. The priority concern is symptomatic hypoglycemia with blood glucose of 57 mg/dL, needing immediate correction compatible with diet. Giving 15 g rapid-acting carbohydrate like clear juice and rechecking in 15 minutes best addresses this for an alert client able to swallow. Administering NPH early risks more lows; high-fat snack is inappropriate; discontinuing diet ignores nutrition. Liquid diets require glucose sources. Symptom assessment guides urgency. A transferable strategy is to adapt treatments to dietary restrictions in insulin-managed hypoglycemia.

Question 5

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?

  1. Plan a consistent meal schedule and include a midafternoon snack to reduce NPH-related lows (correct answer)
  2. Treat blood glucose under 100 mg/dL with a full meal to prevent hypoglycemia
  3. Double the evening NPH dose on days you skip lunch
  4. Take regular insulin immediately after eating to better match food intake

Explanation: 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.

Question 6

A 70-year-old client with type 2 diabetes is admitted for chronic obstructive pulmonary disease exacerbation. Current regimen: NPH insulin 18 units at 0800 and regular insulin 6 units at 0730. At 1100, the client is sweaty and irritable; blood glucose is 59 mg/dL (normal fasting 70–100 mg/dL). The client is alert and requesting water. Which action should the nurse take FIRST in response to the client's hypoglycemia?

  1. Give 2 liters oxygen via nasal cannula to treat irritability
  2. Administer the next scheduled dose of regular insulin to prevent rebound hyperglycemia
  3. Provide 15 g of rapid-acting carbohydrate and recheck blood glucose in 15 minutes (correct answer)
  4. Offer a full meal tray and recheck blood glucose at the next routine check

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a hospitalized client with type 2 diabetes and COPD. The priority concern is symptomatic hypoglycemia with blood glucose of 59 mg/dL, needing immediate correction in an alert client. Providing 15 g of rapid-acting carbohydrate and rechecking in 15 minutes best addresses this for rapid elevation. Administering regular insulin worsens it; offering a full meal delays; oxygen is unrelated. Post-insulin timing requires vigilance. Alertness assessment ensures oral safety. A transferable strategy is to integrate comorbidity effects into glucose monitoring for insulin regimens.

Question 7

A 52-year-old client with type 2 diabetes is in an outpatient clinic for education. Current regimen: insulin glargine 30 units at bedtime and insulin aspart 8 units with meals. The client reports fasting blood glucose readings of 68–75 mg/dL (normal fasting 70–100 mg/dL) on 4 of the last 7 mornings and waking with headache and sweating. Relevant history: chronic kidney disease stage 3. What teaching point is MOST important for the client regarding insulin administration?

  1. Take insulin aspart at bedtime to prevent morning lows
  2. Avoid checking blood glucose when you feel symptoms because it can increase anxiety
  3. Skip the bedtime insulin glargine whenever fasting blood glucose is under 100 mg/dL
  4. Recognize nocturnal hypoglycemia symptoms and treat blood glucose under 70 mg/dL using the 15-15 rule (correct answer)

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a client with type 2 diabetes and kidney disease. The priority concern is recurrent nocturnal hypoglycemia, indicated by low fasting glucose and symptoms like headache and sweating. Teaching to recognize nocturnal symptoms and treat under 70 mg/dL using the 15-15 rule is most important for self-management. Taking aspart at bedtime mismatches its use; avoiding checks increases risk; skipping glargine for low fasting is inappropriate. Kidney disease can prolong insulin action, heightening hypoglycemia risk. Nighttime monitoring prevents severe episodes. A transferable strategy is to review glucose patterns and adjust basal insulin with providers for effective regimen stability.

Question 8

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?

  1. Give 15 g rapid-acting carbohydrate before the meal and recheck blood glucose in 15 minutes (correct answer)
  2. Notify the provider to discontinue all insulin therapy
  3. Administer the scheduled insulin lispro with the lunch tray to prevent hyperglycemia
  4. Encourage the client to eat the entire lunch tray and recheck blood glucose in 2 hours

Explanation: 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.

Question 9

A 42-year-old client with type 1 diabetes is in an outpatient clinic for review of glucose logs. Current regimen: insulin glargine 20 units at bedtime and insulin aspart with meals. The client reports frequent pre-dinner blood glucose readings of 58–68 mg/dL (normal fasting 70–100 mg/dL) with shakiness on days they skip lunch. Relevant history: no cardiovascular disease. What teaching point is MOST important for the client regarding insulin administration?

  1. Use insulin glargine to correct low blood glucose because it lasts longer
  2. If you skip lunch, you should still take your usual mealtime insulin dose to prevent ketones
  3. Carry a fast-acting carbohydrate source and treat blood glucose under 70 mg/dL promptly (correct answer)
  4. Avoid checking blood glucose before dinner because it can vary day to day

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a client with type 1 diabetes and skipped meals. The priority concern is preventing hypoglycemia on days meals are missed, as in pre-dinner lows of 58–68 mg/dL. Teaching to carry fast-acting carbohydrates and treat under 70 mg/dL promptly is most important for safety. Taking mealtime insulin when skipping risks lows; using glargine to correct is incorrect; avoiding checks misses opportunities. Meal skipping requires bolus omission. Consistent monitoring prevents complications. A transferable strategy is to adapt bolus doses to actual intake for stable insulin regimens.

Question 10

A 74-year-old client with type 2 diabetes is admitted for cellulitis. Current regimen: insulin glargine 26 units at bedtime and insulin lispro 7 units with meals. At 1600, the client is confused and diaphoretic; blood glucose is 54 mg/dL (normal fasting 70–100 mg/dL). Vital signs: T 99.1°F (37.3°C), HR 112/min, RR 18/min, BP 146/82 mm Hg. The client is awake and can swallow. Which action should the nurse take FIRST in response to the client's hypoglycemia?

  1. Obtain an order to start an insulin infusion for tighter glucose control
  2. Administer insulin lispro now to prevent infection-related hyperglycemia
  3. Provide a high-protein snack and recheck blood glucose in 1 hour
  4. Administer 15 g rapid-acting carbohydrate and recheck blood glucose in 15 minutes (correct answer)

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a hospitalized client with type 2 diabetes and infection. The priority concern is symptomatic hypoglycemia with blood glucose of 54 mg/dL, needing immediate correction in an awake client able to swallow. Administering 15 g rapid-acting carbohydrate and rechecking in 15 minutes best addresses this for quick glucose rise. Giving lispro now worsens it; starting infusion is for critical cases; high-protein snack is slower-acting. Infections can alter glucose needs, but acute lows require priority treatment. Vital signs monitoring aids assessment. A transferable strategy is to anticipate insulin adjustments during illness for regimen effectiveness.

Question 11

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?

  1. Uses NPH insulin twice daily
  2. Plans to inject regular insulin 30 minutes before meals
  3. Blood glucose 60 mg/dL with palpitations and anxiety (correct answer)
  4. Reports weight loss over the last month

Explanation: 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.

Question 12

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?

  1. Encourage the client to drink 8 oz milk and recheck blood glucose in 1 hour
  2. Give the scheduled NPH insulin to stabilize blood glucose overnight
  3. Notify the provider to change the insulin regimen before treating the low blood glucose
  4. Administer intravenous dextrose per protocol and recheck blood glucose in 15 minutes (correct answer)

Explanation: 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.

Question 13

A 31-year-old newly diagnosed client with type 1 diabetes is learning insulin timing. The regimen is insulin glargine 16 units at bedtime and insulin lispro 1–5 units with meals based on carbohydrate counting. The client reports a blood glucose of 64 mg/dL (normal fasting 70–100 mg/dL) before lunch yesterday with sweating and hunger after skipping breakfast. What teaching point is MOST important for the client regarding insulin administration?

  1. Take insulin lispro 30–60 minutes before meals so it has time to start working
  2. Use extra insulin lispro at lunch to correct the low blood glucose
  3. Stop insulin glargine on days you do not eat three meals
  4. If you skip a meal, hold the mealtime insulin and treat blood glucose under 70 mg/dL with 15 g carbohydrate (correct answer)

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a newly diagnosed client with type 1 diabetes. The priority concern is avoiding hypoglycemia when meals are skipped, as evidenced by pre-lunch blood glucose of 64 mg/dL after missing breakfast. Teaching to hold mealtime insulin when skipping meals and treat under 70 mg/dL with 15 g carbohydrate is most important for safety. Taking lispro 30–60 minutes before mismatches its rapid onset; stopping glargine on low-meal days risks hyperglycemia; using extra lispro at lunch overcorrects. Basal-bolus regimens require matching bolus to intake. Prompt hypoglycemia treatment prevents complications. A transferable strategy is to adjust bolus insulin based on planned carbohydrate intake for effective regimen control.

Question 14

A 19-year-old newly diagnosed client with type 1 diabetes is learning about insulin types. The prescribed regimen is insulin glargine once daily and insulin lispro with meals. The client reports a morning blood glucose of 57 mg/dL (normal fasting 70–100 mg/dL) with sweating after taking insulin lispro but then not eating due to nausea. What teaching point is MOST important for the client regarding insulin administration?

  1. Use insulin lispro at bedtime to prevent fasting hypoglycemia
  2. Stop insulin glargine when you are not eating to prevent lows
  3. Take insulin lispro only when you are ready to eat, and treat blood glucose under 70 mg/dL immediately (correct answer)
  4. Take insulin lispro 30 minutes before meals to prevent post-meal hyperglycemia

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a newly diagnosed client with type 1 diabetes. The priority concern is avoiding hypoglycemia when meals are delayed or missed after bolus insulin, as in the low after nausea. Teaching to take lispro only when ready to eat and treat under 70 mg/dL immediately is most important for timing safety. Taking 30 minutes before risks mismatches; stopping glargine is unsafe; using at bedtime is wrong. Bolus insulin matches meals directly. Symptom recognition enables prompt action. A transferable strategy is to withhold bolus if intake is uncertain for effective regimen management.

Question 15

A 41-year-old client with type 1 diabetes is hospitalized for an asthma exacerbation. Current regimen: NPH insulin 16 units at 0700 and regular insulin 6 units at 0630. At 1200, the client is sweaty and reports dizziness; blood glucose is 61 mg/dL (normal fasting 70–100 mg/dL). The client is alert and can swallow. Which action should the nurse take FIRST in response to the client's hypoglycemia?

  1. Administer a high-protein snack and recheck blood glucose in 2 hours
  2. Administer albuterol to treat dizziness related to asthma
  3. Give 15 g rapid-acting carbohydrate and recheck blood glucose in 15 minutes (correct answer)
  4. Hold the next dose of NPH insulin and document the change

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a hospitalized client with type 1 diabetes and asthma. The priority concern is symptomatic hypoglycemia with blood glucose of 61 mg/dL, needing immediate oral correction in an alert client. Giving 15 g rapid-acting carbohydrate and rechecking in 15 minutes best addresses this for quick resolution. High-protein snack is slower; holding NPH is not acute; albuterol is for asthma, not hypoglycemia. Post-insulin timing requires monitoring. Alertness confirms oral safety. A transferable strategy is to differentiate symptoms from comorbidities in insulin-related hypoglycemia management.

Question 16

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?

  1. Start an insulin infusion per protocol to stabilize blood glucose
  2. Administer 1 mg glucagon intramuscularly and recheck blood glucose in 15 minutes
  3. Hold the next dose of insulin glargine and notify the provider
  4. Give 15 g of rapid-acting carbohydrate (eg, 4 oz juice) and recheck blood glucose in 15 minutes (correct answer)

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a hospitalized client with type 2 diabetes. The priority concern is the client's symptomatic hypoglycemia with a blood glucose of 52 mg/dL, requiring immediate correction to prevent complications like seizures or loss of consciousness. Giving 15 g of rapid-acting carbohydrate and rechecking blood glucose in 15 minutes best addresses this priority as it provides quick glucose elevation for an alert client able to swallow. Administering glucagon is not first-line for conscious clients; holding insulin glargine addresses long-term management but not the acute episode; starting an insulin infusion is inappropriate during hypoglycemia. Timely intervention for hypoglycemia is crucial to restore normal glucose levels and alleviate symptoms. Nurses must assess the client's ability to swallow before choosing oral treatments. A transferable strategy is to always follow the 15-15 rule for hypoglycemia management while monitoring for recurrence in insulin regimens.

Question 17

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?

  1. Take insulin lispro 1 hour after eating to prevent low blood glucose
  2. Skip breakfast when fasting blood glucose is below 90 mg/dL
  3. Decrease the bedtime insulin glargine dose only on days you exercise
  4. Treat any blood glucose under 70 mg/dL with 15 g carbohydrate and recheck in 15 minutes (correct answer)

Explanation: 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.

Question 18

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?

  1. Administer 15 g rapid-acting carbohydrate and recheck blood glucose in 15 minutes (correct answer)
  2. Administer a peanut butter sandwich immediately to provide sustained glucose
  3. Obtain a 12-lead electrocardiogram before treating the hypoglycemia
  4. Give the next scheduled dose of insulin regular to prevent ketosis

Explanation: 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.

Question 19

A 60-year-old client with type 2 diabetes is newly prescribed insulin. The regimen is insulin glargine 10 units at bedtime and insulin regular 4 units subcutaneously 30 minutes before breakfast and dinner. The client asks when to take the regular insulin and reports one episode of shakiness with a blood glucose of 66 mg/dL (normal fasting 70–100 mg/dL) after taking insulin and then delaying breakfast. What teaching point is MOST important for the client regarding insulin administration?

  1. Treat blood glucose under 80 mg/dL by taking the next insulin dose early
  2. Take regular insulin 30 minutes before eating and do not delay the meal after injecting (correct answer)
  3. Skip insulin glargine whenever you plan to eat less the next day
  4. Take regular insulin at bedtime to prevent morning hyperglycemia

Explanation: This question tests the application of insulin management and hypoglycemia intervention in a newly prescribed client with type 2 diabetes. The priority concern is timing regular insulin with meals to prevent hypoglycemia, as seen in the episode after delaying breakfast. Teaching to take regular insulin 30 minutes before eating and not delay the meal best addresses this by matching onset to food absorption. Taking at bedtime is incorrect; skipping glargine for low intake risks highs; treating under 80 mg/dL by early dosing is wrong. Regular insulin requires pre-meal timing for efficacy. Education prevents timing-related lows. A transferable strategy is to educate on insulin action times for synchronized administration in regimens.

Question 20

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?

  1. Give 15 g oral glucose gel and recheck blood glucose in 15 minutes
  2. Call the provider before giving any treatment because the client is NPO
  3. Administer intravenous dextrose per hypoglycemia protocol and recheck blood glucose in 15 minutes (correct answer)
  4. Administer the scheduled insulin glargine to prevent ketosis

Explanation: 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.