# A nurse is caring for a diabetic client who is scheduled for major abdominal surgery in the morning. The client's preoperative blood glucose is 180 mg/dL, and the surgeon has ordered to proceed with surgery. What is the most appropriate nursing intervention at this time? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=177238 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a diabetic client who is scheduled for major abdominal surgery in the morning. The client's preoperative blood glucose is 180 mg/dL, and the surgeon has ordered to proceed with surgery. What is the most appropriate nursing intervention at this time? The nurse must determine the best approach for managing a diabetic client's elevated preoperative blood glucose level. ## 보기 1. Administer the client's usual morning insulin dose as prescribed 2. Contact the physician to clarify insulin management and glucose monitoring protocols **✔ 정답** 3. Hold all insulin until after the surgical procedure is completed 4. Give the client a light snack to prevent hypoglycemia during surgery **정답: 2** ## 해설 Preoperative management of diabetic clients requires careful coordination between nursing and medical teams to prevent both hyperglycemia and hypoglycemia during surgery. Perioperative management of diabetic patients requires specialized protocols to maintain glucose homeostasis and prevent complications. A blood glucose of 180 mg/dL is an elevated level that requires intervention, but coordination with the surgical and anesthesia teams is essential. The most appropriate nursing intervention is to contact the physician to clarify insulin management and blood glucose monitoring protocols. Surgery induces significant physiological stress that affects glucose metabolism through increases in cortisol, epinephrine, and other stress hormones. This stress response typically elevates blood glucose levels, complicating perioperative glucose management. Proper perioperative diabetes management involves several considerations: timing of insulin administration, type of insulin to use, frequency of blood glucose monitoring, and coordination with anesthesia protocols. Many healthcare facilities have specific perioperative diabetes protocols that include insulin infusions, modified insulin regimens, or specific monitoring schedules. While elevated preoperative blood glucose indicates the need for intervention, this must be done safely and in coordination with the medical team. The physician should provide specific orders for insulin administration, blood glucose monitoring frequency, and target blood glucose ranges during the perioperative period. Effective communication between the nursing team and the medical team is essential for safe perioperative management of diabetic patients. The nurse's role is to advocate for appropriate medical management while ensuring patient safety through proper monitoring and intervention protocols. ## 심화 해설 Understanding the Clinical Situation The client has a known history of diabetes and presents with a preoperative blood glucose of 180 mg/dL. While this value is elevated, the surgeon has decided to proceed with the major abdominal surgery. The nurse's primary responsibility is not to independently manage this hyperglycemia, but to ensure a clear, safe, and evidence-based plan for perioperative glycemic control is in place, as perioperative hyperglycemia is strongly linked to increased risks of postoperative complications, including infections and prolonged hospital stay [1]. Analysis of Options The most appropriate intervention is to contact the physician to clarify insulin management and glucose monitoring protocols. The surgeon's order to "proceed with surgery" is a directive about the surgical schedule, but it does not constitute a complete medical order for managing the client's diabetes during the perioperative period. Given the elevated glucose level, a clear, multi-disciplinary plan is essential to mitigate risks. The nurse must advocate for the client by obtaining specific orders that address the intraoperative and immediate postoperative phases. Why Other Options Are Incorrect - Administering the client's usual morning insulin dose as prescribed is a high-risk action without a current, verified order that is specific to the preoperative setting. The client will be NPO (nothing by mouth) for surgery, and their usual subcutaneous insulin regimen, designed for a normal dietary intake and activity level, could precipitate dangerous hypoglycemia under the stress and fasting conditions of surgery. The nurse cannot assume a home medication schedule is safe to administer in the hospital without explicit provider direction. - Holding all insulin until after the surgical procedure is completed is equally dangerous. Uncontrolled hyperglycemia during surgery increases the risk of poor outcomes. The American Diabetes Association's standards for hospital care emphasize the importance of managing glucose levels, and simply withholding insulin allows hyperglycemia to persist or worsen, directly contradicting the goal of reducing perioperative risk [2]. - Giving the client a light snack to prevent hypoglycemia during surgery is contraindicated. The client is NPO for major abdominal surgery to prevent aspiration. Administering any food would violate a critical safety protocol and put the client at severe risk of pulmonary aspiration during anesthesia induction. The Pathophysiology and Clinical Rationale The stress of surgery triggers a counter-regulatory hormone response (e.g., cortisol, catecholamines), which promotes hepatic glucose production and insulin resistance, often leading to intraoperative hyperglycemia . This metabolic state impairs immune function and wound healing, directly increasing the risk of surgical site infections and periprosthetic joint infections, a risk that is more than doubled in patients with diabetes . A proactive, clarified plan for insulin management—whether through a variable-rate intravenous insulin infusion or a modified subcutaneous insulin regimen with frequent glucose monitoring—is the cornerstone of safe care. This plan must be explicitly ordered by the provider to balance the risks of hyperglycemia against the catastrophic risk of intraoperative hypoglycemia, which can be masked under anesthesia [1,2]. The nurse's role is to recognize the incomplete nature of the initial order and seek the necessary clarification to ensure a safe transition through the perioperative continuum.References (research sources) - [1]Perioperative screening and management of hyperglycemia: a joint position statement from the Brazilian Diabetes Society (SBD), the Brazilian Society of Anesthesiology (SBA) and the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO).Research articleMarino EC, Negretto LAF, Ribeiro RS, Momesso D, Feitosa ACR, Toyoshima MTK, da Silva Junior JC, Vencio S, Lauria MW, de Sá JR, Malerbi DA, Valente F, Leite SAO, Amaral DEO, Guimarães GMN, da Cunha Leal P, Lopes MB, Salles LCB, de Araújo Azi LMT, Fonseca AG, Carvalho LIM, Coelho FF, Halpern B, Valerio CM, Trujilho FR, Brandão ACA, Lyra R, Bertoluci M. (2026) · DOI: 10.1186/s13098-025-02060-5 - [2]16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2026.Research articleAmerican Diabetes Association Professional Practice Committee for Diabetes* . (2026) · DOI: 10.2337/dc26-s016 ## 임상 시나리오 Perioperative Glycemic ManagementClarifying Orders for the NPO Diabetic Patient A surgeon's order to proceed with surgery is not a complete order for perioperative insulin management. The nurse must obtain specific, multidisciplinary orders for glucose monitoring and insulin administration. For a client with a preoperative glucose of 180 mg/dL who is NPO, the usual subcutaneous insulin regimen is unsafe without adjustment. The plan must account for fasting status and the stress response of surgery. CautionNever administer a diabetic patient's usual insulin dose preoperatively without a verified, current order. The combination of NPO status and unadjusted insulin can cause severe hypoglycemia. ## 핵심 개념 - **Perioperative Hyperglycemia** — Elevated blood glucose before, during, or after surgery, linked to increased risk of surgical site infections and delayed wound healing. - **NPO Status** — Nothing by mouth; a standard preoperative order to ensure an empty stomach, reducing the risk of pulmonary aspiration during anesthesia. ## 같은 주제 문제 - [A nurse is conducting a preoperative assessment on a 22-year-old client with type 1 diabet…](https://mymerci.kr/pages/nclex_q.php?qn_id=177231) - [A nurse is caring for a diabetic client scheduled for Tonsillectomy in the morning. 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