# Stage 1 — Recognize cues. Review the 0515 event summary. Highlight the findings that require the nurse's follow-up. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617304&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question Stage 1 — Recognize cues. Review the 0515 event summary. Highlight the findings that require the nurse's follow-up. 0515 event summary. Mr. P, 56, has had type 1 diabetes for 30 years and was admitted 36 hours ago with diabetic ketoacidosis; the DKA resolved yesterday evening, and he now receives a basal-bolus subcutaneous insulin regimen. His creatinine is 0.9 mg/dL. During an EHR outage, a one-time correction dose was ordered for a glucose of 286 mg/dL at 0400; the prescriber intended regular insulin 10 units, and the paper order read "10U." The night RN, who has six months of experience, gave regular insulin 100 units at 0430. At 0500 Mr. P was diaphoretic, tremulous, and confused with a glucose of 38 mg/dL. Because he had a patent IV and could not safely swallow, prescribed IV dextrose was given; glucagon remained available. At 0515 he is alert and oriented, the glucose is now 124 mg/dL, and SpO2 is 98 percent on room air. His next glucose check at 0730 is the unit routine, and his mealtime insulin is due at 0800. His daughter is at the bedside. ## Explanation The follow-up findings are the 100-unit dose given for an intended 10 units, the symptomatic glucose of 38 mg/dL that requires continued 15-minute rechecks, and scheduled mealtime insulin at 0800 that must be held for prescriber review because the overdose will still be acting. The 0515 glucose of 124 mg/dL (not selectable) is a single post-dextrose value, not evidence of resolution. The 30-year diabetes history, resolved DKA, and the 0400 hyperglycemia are real but explained context, and normal creatinine means renal clearance is not an added concern. The next glucose check is not planned until 0730, far too late while 100 units of regular insulin are still acting; hourly (or more frequent) glucose monitoring is needed. ## In-depth explanation Quick answer Highlight **regular insulin 100 units at 0430**, **glucose of 38 mg/dL**, and **mealtime insulin is due at 0800**. Why this is correct The dose is tenfold what was intended, and subcutaneous regular insulin peaks about 2 to 3 hours after injection and acts longer at very large doses, so its peak effect has not yet arrived at 0515. The normal 0515 glucose of 124 mg/dL after one dextrose dose is therefore a trap, not a finish line; frequent point-of-care checks, ongoing dextrose, and potassium monitoring must continue. The next scheduled insulin dose must be held pending prescriber review, or the client will receive more insulin while the overdose is still active. A routine next check at 0730 leaves hours of peak and ongoing insulin action unmonitored. Easy analogy or mental picture Think of a flood from a dam that opened at 0430: bailing out the basement once (the dextrose) makes the floor look dry at 0515, but the peak wave has not arrived yet, and someone is scheduled to open the gate again at 0800. Memory hook One good number is not a cure while the insulin is still peaking. NCLEX decision rule After an insulin overdose, judge the risk by the timing of the insulin's action, not by the most recent glucose value; hold further scheduled insulin until the prescriber reviews the plan. Why the other choices are wrong **Type 1 diabetes for 30 years** is a chronic background factor (and can blunt hypoglycemia awareness), but it is not a current finding that needs action by itself. **DKA resolved yesterday evening** is tempting as a recent crisis, but resolution means it is not the active threat. **Glucose of 286 mg/dL at 0400** was the explained reason for the correction dose and has been superseded. **Creatinine is 0.9 mg/dL** is normal, so impaired insulin clearance is not an added concern. **Six months of experience** is context for the system review, not a clinical finding or proof of fault. **Had a patent IV** explains why IV dextrose was the chosen route, and **SpO2 is 98 percent** is normal. References 1ISMP List of Error-Prone Abbreviations, Symbols, and Dose DesignationsThe abbreviation U for units has been mistaken for a zero, causing tenfold insulin overdoses 2ADA Standards of Care in Diabetes—2025 (Diabetes Care Supplement 1)Hypoglycemia classification, treatment, and in-hospital recurrence monitoring ## Clinical scenario Scenario (Stage 1 — Recognize cues) During an EHR outage, a handwritten correction-insulin order is misread, and a client recovering from DKA develops symptomatic hypoglycemia that responds to IV dextrose. ## Key concepts - **Regular insulin** — Short-acting insulin that, given subcutaneously, begins acting in about 30 minutes, peaks in about 2 to 3 hours, and lasts longer when the dose is very large. - **Level 3 hypoglycemia** — Hypoglycemia with altered mental or physical status requiring assistance from another person for treatment. - **Error-prone abbreviation** — A notation such as 'U' for units that can be misread (for example as a zero) and is on ISMP's do-not-use list. ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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