# A 55-year-old client newly on a sliding-scale insulin (lispro) regimen before meals asks the nurse what to do at each measurement. Which response is correct? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375040&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 55-year-old client newly on a sliding-scale insulin (lispro) regimen before meals asks the nurse what to do at each measurement. Which response is correct? ## Option 1. Inject the prescribed lispro dose 30 minutes before the meal, measure capillary blood glucose 2 hours after completing the meal, record the value, notify the healthcare provider if the result is less than 70 mg/dL or exceeds 400 mg/dL, and use that glucose level to adjust the next pre-meal lispro dose according to the sliding scale. 2. Check capillary blood glucose before each meal; if the reading is above 200 mg/dL, omit the lispro injection to prevent hypoglycemia since the body is already experiencing high blood sugar, consume your meal, document the value, and notify the provider for readings below 70 mg/dL or above 400 mg/dL. 3. Check capillary blood glucose immediately before each meal, give the lispro dose specified for that glucose range on the sliding scale, eat the meal within about 15 minutes of injection, document the reading and dose, and report blood glucose less than 70 mg/dL or greater than 400 mg/dL to the provider. **✔ Correct answer** 4. Check capillary blood glucose before each meal, administer a fixed dose of lispro that does not depend on the reading, eat your meal within 15 minutes, document the blood glucose result, and notify the provider if the value is less than 70 mg/dL or greater than 400 mg/dL. **Correct answer: 3** ## Explanation Sliding-scale insulin — correct technique Sliding-scale insulin (SSI) is a reactive regimen — the dose depends on the current capillary blood glucose. Standard process: (1) Check fingerstick blood glucose immediately before the meal (or per institution). (2) Look up the dose on the sliding scale for that glucose range. (3) Administer the rapid-acting insulin (lispro/aspart/glulisine) and eat the meal within ~15 minutes (rapid onset 5-15 min, peak 30-90 min). With regular insulin, inject 30 minutes before the meal. (4) Document the BG reading, dose, and time. (5) Report extremes: BG 400 mg/dL (or per institutional thresholds) to the provider for additional intervention (correction insulin, fluids, work-up). (6) Watch for hypoglycemia post-meal during the rapid-acting peak. Sliding-scale alone is generally outdated as primary management for sustained hyperglycemia (basal-bolus is preferred), but it is still common as a correction-dose addition or for short hospital stays. Other options: fixed dose ignores glucose value; skipping dose at high BG worsens hyperglycemia; lispro injects with the meal (not 30 min before — that is regular). ## In-depth explanation Clinical reasoning summary Sliding-scale insulin — correct technique Sliding-scale insulin (SSI) is a reactive regimen — the dose depends on the current capillary blood glucose. Standard process: (1) Check fingerstick blood glucose immediately before the meal (or per institution). (2) Look up the dose on the sliding scale for that glucose range. (3) Administer the rapid-acting insulin (lispro/aspart/glulisine) and eat the meal within ~15 minutes (rapid onset 5-15 min, peak 30-90 min). With regular insulin, inject 30 minutes before the meal. (4) Document the BG reading, dose, and time. (5) Report extremes: BG 400 mg/dL (or per institutional thresholds) to the provider for additional intervention (correction insulin, fluids, work-up). (6) Watch for hypoglycemia post-meal during the rapid-acting peak. Sliding-scale alone is generally outdated as primary management for sustained hyperglycemia (basal-bolus is preferred), but it is still common as a correction-dose addition or for short hospital stays. Other options: fixed dose ignores glucose value; skipping dose at high BG worsens hyperglycemia; lispro injects with the meal (not 30 min before — that is regular). ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en) - [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375040&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375040&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375040&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375040&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375040&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. 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