# A nurse is preparing a 63-year-old client with type 2 diabetes mellitus for a scheduled coronary artery bypass graft (CABG). The client has been NPO since midnight and received their usual long-acting insulin the previous evening. At 6:00 AM, the client reports mild nausea, and their blood glucose level is 180 mg/dL. To ensure optimal perioperative safety, what is the nurse's priority action? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540481 > language: ko > subject: Adult Health ## 문제 A nurse is preparing a 63-year-old client with type 2 diabetes mellitus for a scheduled coronary artery bypass graft (CABG). The client has been NPO since midnight and received their usual long-acting insulin the previous evening. At 6:00 AM, the client reports mild nausea, and their blood glucose level is 180 mg/dL. To ensure optimal perioperative safety, what is the nurse's priority action? ## 보기 1. Administer the client's regular morning insulin dose as prescribed 2. Notify the surgeon immediately to cancel the surgery due to hyperglycemia 3. Continue with preoperative preparations as the glucose level is acceptable for surgery 4. Contact the physician to obtain orders for insulin coverage and glucose monitoring **✔ 정답** **정답: 4** ## 해설 Priority action for diabetic surgical clients with elevated preoperative glucose levels This question evaluates blood sugar management in diabetic patients before surgery and the nurse's ability to prioritize. A blood glucose of 180 mg/dL is elevated but not high enough to automatically cancel surgery. However, immediate intervention is needed to prevent complications during and after surgery. The correct answer is to contact the physician for insulin orders and blood glucose monitoring instructions. High blood sugar in surgical patients increases the risk of infection, delayed wound healing, and other complications. The nurse needs specific physician orders for insulin administration and monitoring protocols during the perioperative period. Diabetic patients undergoing surgery generally require careful management to maintain blood glucose in the range of 80-180 mg/dL (or 100-140 mg/dL at some institutions). The stress response from surgery, anesthesia, and fasting can significantly affect blood sugar levels. Without proper insulin orders, the patient's blood glucose could rise dangerously during surgery. The nurse should also consider that the patient has been fasting since midnight and received evening insulin, which can lead to unpredictable blood glucose patterns. Proper perioperative diabetes management requires individualized insulin protocols, frequent monitoring, and collaboration with the physician to ensure optimal outcomes and prevent complications such as diabetic ketoacidosis or severe hypoglycemia. ## 심화 해설 Perioperative Glycemic Management in CABG The client's blood glucose of 180 mg/dL in the setting of NPO status and mild nausea requires a nuanced response. The priority is not to cancel the surgery or to blindly administer a routine insulin dose, but to communicate the need for a tailored perioperative insulin and monitoring plan. Why Hyperglycemia Matters Perioperatively Hospital hyperglycemia, defined as a blood glucose level above 140 mg/dL, is a significant risk factor for adverse surgical outcomes. The physiological stress of surgery triggers a counter-regulatory hormone response (cortisol, catecholamines), promoting hepatic glucose production and insulin resistance. This is compounded by the patient's underlying type 2 diabetes mellitus. The provided consensus guidelines clearly state that hyperglycemia increases the risk of postoperative complications, particularly infections, prolonged hospital stay, and in-hospital mortality [1]. Ensuring adequate glycemic control during the perioperative period is therefore essential to reduce these risks and improve surgical outcomes [1]. Analyzing the Options - Option 1 (Administer regular morning insulin): This is unsafe without a current order that accounts for the client's NPO status and nausea. Administering a full subcutaneous insulin dose to a patient who is NPO and nauseated could precipitate dangerous hypoglycemia, a critical safety event. - Option 2 (Notify surgeon to cancel surgery): A glucose level of 180 mg/dL is a moderate elevation, not a critical value that typically necessitates cancellation of a necessary procedure like CABG. The guidelines focus on management, not cancellation, for this level of hyperglycemia [1,2]. - Option 3 (Continue preparations as acceptable): This is incorrect. A level of 180 mg/dL is above the recommended target range and requires intervention, not passive acceptance. The standard of care dictates active management to mitigate the documented risks of infection and poor wound healing [1,2]. - Option 4 (Contact physician for insulin coverage and monitoring orders): This is the priority action. It directly addresses the hyperglycemia while ensuring patient safety. The physician can provide a tailored order, often for a correctional dose of rapid-acting insulin or an adjustment to an intravenous insulin infusion protocol, along with a specific frequency for blood glucose monitoring. This aligns with the guideline recommendation for ensuring adequate glycemic control through a structured plan [1,2]. The nurse's role is to recognize that the current glucose level, while not an emergency, is outside the safe target range and requires a collaborative, provider-directed intervention to mitigate perioperative risk. The established standards of care emphasize the necessity of a proactive glycemic management strategy in the hospital setting to prevent complications .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 ## 임상 시나리오 Perioperative Insulin ManagementSafe Glycemic Control for NPO Surgical Patients For a patient on long-acting insulin who is NPO and nauseated, a routine morning insulin dose is unsafe. The priority is to contact the physician for a tailored order, often involving an insulin infusion or adjusted subcutaneous dose with a dextrose-containing IV fluid. A blood glucose of 180 mg/dL in a hospitalized surgical patient is above the 140 mg/dL threshold for hyperglycemia and requires intervention to reduce risks of postoperative infection and mortality. CautionNever administer a full subcutaneous insulin dose to an NPO patient without a current, verified order. The combination of fasting and nausea creates a high risk for severe hypoglycemia, a major patient safety event. ## 핵심 개념 - **Perioperative Hyperglycemia** — Blood glucose >140 mg/dL during the surgical period, increasing risks of infection, mortality, and poor outcomes due to stress-induced insulin resistance. - **Counter-regulatory Hormones** — Hormones like cortisol and catecholamines released during surgical stress that increase hepatic glucose production and peripheral insulin resistance. - **NPO Status** — Nothing by mouth; a preoperative fasting state that significantly increases the risk of hypoglycemia if routine insulin doses are administered without adjustment. ## 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=540471) - [A nurse is caring for a diabetic client scheduled for Tonsillectomy in the morning. 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