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?
- Administer 15 g rapid-acting carbohydrate orally and recheck blood glucose in 15 minutes (correct answer)
- Administer insulin lispro with the next meal to prevent hyperglycemia
- Notify the provider to obtain an order for a continuous dextrose infusion
- Teach the client to rotate injection sites to improve insulin absorption
Explanation: 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.