A client received NPH insulin at 0730. At 1400 the client is alert but shaky and sweaty, and the blood glucose is 54 mg/dL. Complete the treatment statement.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
NPH is an intermediate-acting insulin with variable timing; FDA pharmacodynamic data describe a median maximum effect near 6.5 hours, with a broad range. Shakiness, sweating, and glucose 54 mg/dL require immediate treatment rather than waiting for a meal. For an alert adult who can swallow, give 15 g of fast-acting carbohydrate, recheck glucose in 15 minutes, and repeat if the glucose remains below 70 mg/dL or is not rising according to protocol. After recovery, reassess the insulin-meal-activity pattern and notify the prescriber as indicated to prevent recurrence.
Correct Answer Recognize symptomatic hypoglycemia, give 15 g of fast-acting carbohydrate because the client can swallow, and recheck in 15 minutes with repeat treatment if the glucose remains low.
Why It Fits The 1400 event occurs 6.5 hours after the NPH dose, within the medication's variable period of strongest effect. The measured glucose and adrenergic symptoms confirm the immediate problem.
Clinical Picture Consciousness and swallowing ability determine the route. An alert client can receive oral fast-acting carbohydrate; a client who cannot swallow safely needs the facility's severe-hypoglycemia pathway rather than oral intake.
Memory Link Low and awake: 15 g now, recheck in 15 minutes, repeat if still low.
NCLEX Rule Treat the measured emergency first, then investigate the medication, meal, activity, renal function, and other factors that may have contributed.
Why the Alternatives Fail Long-acting insulin worsens the low. A high-fat food acts too slowly for initial correction. Fluid restriction does not raise glucose, and observation alone allows neurologic deterioration.
Source
1FDA HUMULIN N Prescribing Information
2CDC Diabetes Toolkit: 15-15 Rule
32026 NCLEX-RN Test Plan
The client can swallow safely and has no IV access. The nurse has fast-acting carbohydrate available and follows the facility's hypoglycemia protocol while reviewing the insulin, meal, activity, and glucose pattern.
NPH insulin — An intermediate-acting insulin with variable onset, maximum effect, and duration; glucose patterns must be assessed rather than relying on one fixed peak time.
15-15 rule — For most conscious adults with glucose at or below 70 mg/dL, give 15 g of fast-acting carbohydrate and recheck glucose in 15 minutes.
Fast-acting carbohydrate — A rapidly absorbed carbohydrate source such as glucose tablets, glucose gel, or juice used for initial treatment of mild-to-moderate hypoglycemia.