# A 22-year-old client with type 1 diabetes who uses an insulin pump is admitted to the medical unit with nausea. At 0700, capillary glucose was 318 mg/dL and the client gave a correction bolus through the pump. At 0900, glucose is 324 mg/dL, capillary beta-hydroxybutyrate is 1.6 mmol/L, and the client has vomited once. The infusion set was inserted 3 days ago, the tubing has no visible air, and the pump shows no occlusion alarm. Which actions should the nurse take? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617279&lang=en > language: en > subject: Medication Administration > category: PPT ## Question A 22-year-old client with type 1 diabetes who uses an insulin pump is admitted to the medical unit with nausea. At 0700, capillary glucose was 318 mg/dL and the client gave a correction bolus through the pump. At 0900, glucose is 324 mg/dL, capillary beta-hydroxybutyrate is 1.6 mmol/L, and the client has vomited once. The infusion set was inserted 3 days ago, the tubing has no visible air, and the pump shows no occlusion alarm. Which actions should the nurse take? Select all that apply. 1 Deliver a second correction bolus through the pump right away. 2 Suspend the pump until the client can keep oral fluids down. 3 Set a higher temporary basal rate and keep the current infusion site. 4 Replace the infusion set and insert the cannula at a new site. 5 Give the correction dose by pen or syringe instead of the pump. 6 Recheck capillary glucose and ketones in about 2 hours. ## Explanation Glucose that does not fall 2 hours after a pump correction bolus, together with ketones, means insulin delivery is presumed to have failed even without an alarm. The nurse gives the correction by injection, replaces the set at a new site, and rechecks glucose and ketones about every 2 hours. Another pump bolus or a higher temporary basal still depends on the suspect set, and suspending the pump removes all basal insulin and accelerates DKA. ## In-depth explanation Quick answer Options 5, 4, and 6: inject the correction, change the set and site, and recheck glucose and ketones. Why this is correct A correction bolus normally lowers glucose within 2 hours. Here the value rose from 318 to 324 mg/dL and beta-hydroxybutyrate is 1.6 mmol/L, so the client is developing ketosis. Occlusion alarms detect only complete blockage; a partly dislodged or kinked cannula under the skin can deliver little insulin with no alarm. The safe response is to bypass the pump with an injection, replace the set at a new site, and recheck glucose and ketones about every 2 hours to confirm the trend reverses. Easy analogy or mental picture If a garden hose is not watering the plant, you do not turn the tap up; you use a watering can now and replace the hose. Memory hook No drop in 2 hours + ketones = needle, not pump: inject, change, recheck. NCLEX decision rule When an insulin pump correction fails and ketones are present, treat the pump route as unreliable until proven otherwise; never remove basal insulin in type 1 diabetes. Why the other choices are wrong Second pump bolus (option 1): tempting because correction boluses are the usual response to high glucose, but it uses the same failed delivery route. Suspending the pump (option 2): tempting because the client is nauseated and vomiting, but a pump supplies the only basal insulin, so stopping it speeds ketoacidosis. Higher temporary basal at the current site (option 3): temporary basal increases are a real sick-day tool, but they cannot work through a set that is not delivering insulin. References 1ADA Standards of Care in Diabetes-2025Insulin pump use, ketone monitoring, and sick-day management in type 1 diabetes 2Adult Diabetic Ketoacidosis (StatPearls)Interrupted insulin delivery from pump failure as a precipitant of DKA ## Clinical scenario Scenario A young adult with type 1 diabetes on an insulin pump has persistent hyperglycemia and rising ketones despite a pump correction bolus 2 hours earlier; the pump shows no alarm. ## Key concepts - **Continuous subcutaneous insulin infusion** — Delivery of rapid-acting insulin by pump as basal and bolus doses with no long-acting insulin on board. - **Beta-hydroxybutyrate** — The main ketone body measured in blood; rising values during hyperglycemia signal insulin deficiency. - **Infusion set failure** — Partial or complete interruption of insulin delivery from a kinked, dislodged, or aged cannula, often without an alarm. ## Related questions - [Before giving a scheduled dose of digoxin, the nurse obtains an apical pulse of 54/min in …](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [An older adult taking digoxin reports nausea, poor appetite, and yellow-green halos. 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