Stage 3 — Prioritize hypotheses. Mr. P, 56, has type 1 diabetes; his diabetic ketoacidosis resolved yesterday evening and he now receives basal-bolus subcutaneous insulin. Creatinine is 0.9 mg/dL. At 0430, during an EHR outage, he received regular insulin 100 units subcutaneously for a glucose of 286 mg/dL; the intended dose was 10 units. At 0500 he was diaphoretic, tremulous, and confused with a glucose of 38 mg/dL and received prescribed IV dextrose. At 0515 he is alert and oriented, glucose is 124 mg/dL, and SpO2 is 98% on room air. The unit's next routine glucose check is 0730, and mealtime insulin is due at 0800. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Quick answer
Condition: ongoing hypoglycemia risk from a tenfold regular-insulin overdose. Actions: hold the 0800 mealtime insulin and notify the prescriber, and recheck capillary glucose every 15 minutes. Monitor: capillary blood glucose and serum potassium.

Why this is correct
Subcutaneous regular insulin peaks about 2 to 3 hours after injection and lasts several hours longer; a 100-unit dose given at 0430 will still be driving glucose down well after 0515, while an IV dextrose bolus is short-acting. Frequent capillary checks catch a fall early, and giving more insulin at 0800 would stack on the overdose. Insulin also moves potassium into cells, so serum potassium is the second parameter that tracks the excess-insulin effect.

Easy analogy or mental picture
A 100-unit depot under the skin is a tap left running into a sink, and the dextrose is one bucket bailed out. Until the tap runs dry, the nurse keeps checking the water level.

Memory hook
Big insulin dose, long tail: monitor for the whole duration of action.

NCLEX decision rule
After an insulin overdose, keep monitoring for the full duration of the insulin's action and hold any further insulin until the prescriber reassesses; choose parameters the insulin itself changes (glucose and potassium).

Why the other choices are wrong
Isolated, already-corrected hypoglycemia does not fit a 100-unit regular-insulin dose given 45 minutes earlier that has not yet reached its peak. Recurrent DKA and ketone or anion-gap tracking are the wrong direction: DKA resolved yesterday and the current problem is too much insulin, not too little. A transient ischemic attack is excluded because the confusion cleared as soon as glucose was corrected. Waiting for the 0730 routine check leaves more than two hours unmonitored during peak action. Glucagon is a rescue drug for a low glucose that cannot be treated orally or by IV, not a preventive dose. Restarting an insulin infusion adds insulin to an overdose. Hemoglobin A1C reflects months of control, not the next few hours.