Nclexrn Quiz: Insulin Regimens And Hypoglycemia Management
20 questions · exam conditions
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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
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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.

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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 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 while awaiting the next scheduled meal
  2. Administer 1 mg glucagon intramuscularly and recheck blood glucose in 15 minutes while preparing a snack
  3. Hold the next dose of insulin glargine and notify the provider of the current glucose reading
  4. Give 15 g of rapid-acting carbohydrate (eg, 4 oz juice) and recheck blood glucose in 15 minutes (correct answer)
Explanation: 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.

Question 4

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?

  1. If you wake up feeling sweaty at night, take an extra 4 units of insulin glargine and recheck in 30 minutes.
  2. Keep glucose tablets at the bedside and treat blood glucose under 70 mg/dL using the 15-15 rule (correct answer)
  3. Take insulin lispro at bedtime rather than with dinner to prevent low blood glucose during the night and reduce awakenings.
  4. Stop waking to check blood glucose at night; sleep is more important than a low reading, and check in the morning instead.
Explanation: 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.

Question 5

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 and switch to a calorie-controlled diabetes diet
  3. Provide a high-fat snack (eg, peanut butter) to slow glucose absorption and prevent recurrent hypoglycemia
  4. Administer the next dose of NPH insulin early to keep blood glucose from rising above 200 mg/dL
Explanation: Symptomatic hypoglycemia at 57 mg/dL needs immediate glucose replacement, and because the client is alert with an intact swallow, oral treatment is appropriate. The correct action is to give 15 g of a rapid-acting carbohydrate such as clear juice and recheck the blood glucose in 15 minutes. Notifying the provider to switch from a clear liquid diet to a calorie-controlled diabetes diet addresses a meal order, not the current low blood glucose. A high-fat snack such as peanut butter slows gastric emptying and is too slow to correct acute hypoglycemia. Giving the next NPH insulin early adds more insulin while blood glucose is already low and can worsen the hypoglycemia. The rapid-acting carbohydrate plus 15-minute recheck is the only option that directly treats the low and includes the needed follow-up assessment.

Question 6

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 and will cover the carbohydrate you eat.
  2. Use extra insulin lispro at lunch to correct the low blood glucose you had before the meal and prevent symptoms from returning.
  3. Stop insulin glargine on days you do not eat three meals because skipping food means your body needs less background insulin.
  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: Your blood glucose before lunch is 64 mg/dL and you had symptoms after skipping breakfast. The danger is that a mealtime insulin dose meant for food you did not eat will push you lower. The correct safety teaching is: when you skip a meal, hold the rapid-acting mealtime insulin, and if glucose is under 70 mg/dL, treat right away with about 15 g of fast-acting carbohydrate. Taking lispro 30–60 minutes before meals is incorrect because lispro is rapid-acting and should be given within about 15 minutes of eating; the longer wait lets it peak before food and can worsen hypoglycemia. Using extra lispro at lunch is the opposite of what is needed—insulin lowers glucose, so more insulin would drop it further instead of correcting the low. Stopping insulin glargine on days you skip a meal removes the basal insulin your body still needs, leading to hyperglycemia or ketoacidosis; basal insulin is not adjusted meal-by-meal for skipped meals. Therefore, the priority teaching is to hold the mealtime insulin and treat the low with 15 g carbohydrate.

Question 7

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?

  1. Avoid treating low blood glucose readings until they drop below 50 mg/dL, even when symptoms are present
  2. Take mealtime insulin at bedtime if you eat less during the day so your total insulin dose stays stable
  3. Increase your basal insulin dose when you eat less so that blood glucose remains steady with smaller meals
  4. Match mealtime insulin to the amount you will eat and keep fast-acting carbohydrates available for lows (correct answer)
Explanation: 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.

Question 8

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 20 units of insulin glargine and notify the provider of the current blood glucose.
  3. Administer 1 mg of glucagon intramuscularly and place the client in high-Fowler's position to protect the airway.
  4. Start an intravenous infusion of regular insulin per sliding-scale protocol and reassess blood glucose in 30 minutes.
Explanation: 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.

Question 9

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 10

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 11

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 12

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 13

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 14

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 15

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 16

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 17

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 morning hypoglycemia because it provides a slow, steady release of insulin overnight
  2. Stop insulin glargine when you are not eating so the missed food will prevent low blood glucose from developing
  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 so it can peak when the food starts to raise the blood glucose
Explanation: The priority is preventing hypoglycemia in a client who took rapid-acting insulin but could not eat. Insulin lispro is a mealtime bolus insulin, so it should be given only when the client is ready to eat; if a meal is skipped, the dose should be held. Because the reported morning glucose is 57 mg/dL (below 70), the client also needs immediate treatment of hypoglycemia, and nausea should not delay that. Using lispro at bedtime is wrong: lispro peaks quickly and wears off in hours, so it cannot provide overnight basal coverage and could cause nocturnal low. Stopping glargine when meals are missed is also wrong: glargine is basal insulin needed to prevent ketosis, and omitting it creates risk of hyperglycemia and DKA. Giving lispro 30 minutes before meals is too early for a rapid-acting insulin; the usual timing is about 15 minutes before or immediately before food, and 30 minutes can cause hypoglycemia before the meal is eaten. Therefore, the most important teaching is to match lispro to an actual meal and treat any glucose under 70 mg/dL right away.

Question 18

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 19

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 20

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.