NCLEX Question of the Day – Friday, April 24, 2026

Today’s question focuses on Pharmacology, specifically safe insulin administration and early recognition of hypoglycemia. This matters in real nursing because insulin errors can harm a patient fast. A nurse has to notice subtle changes, connect them to the medication timeline, and act in the right order.

Clinical Scenario

A 67-year-old man is admitted to a medical-surgical unit with community-acquired pneumonia and type 2 diabetes mellitus. He normally takes oral diabetes medication at home, but while hospitalized he is receiving subcutaneous insulin based on blood glucose checks. At 1130, his capillary blood glucose is 248 mg/dL. The provider’s order reads:

• Insulin lispro 6 units subcutaneously with lunch
• Hold insulin if the meal tray is not available

The nurse gives the insulin at 1145 after the dietary aide says the tray is on the way. At 1215, the nurse enters the room and finds that the patient’s lunch tray has not arrived. The patient is awake but says, “I feel shaky and sweaty.” He appears pale and slightly confused. A repeat capillary blood glucose is 58 mg/dL.

The Question

What is the nurse’s priority action?

Answer Choices

1. Administer 15 g of rapid-acting carbohydrate and recheck blood glucose in 15 minutes
2. Document the findings and notify the provider that the lunch tray is delayed
3. Give the scheduled lunchtime insulin dose again once the meal tray arrives
4. Place the patient flat in bed and apply oxygen at 2 L/min by nasal cannula

Correct Answer

A. Administer 15 g of rapid-acting carbohydrate and recheck blood glucose in 15 minutes

Detailed Rationale

This patient has symptomatic hypoglycemia. The key clues are the timing, the symptoms, and the glucose value. Insulin lispro is rapid-acting. It starts working quickly, so if food is delayed after administration, blood glucose can drop before the patient has carbohydrate intake. That is exactly what happened here.

The nurse should first confirm that the patient can swallow safely. In this case, the patient is awake and able to report symptoms, so oral treatment is appropriate. The standard immediate response is to give 15 g of rapid-acting carbohydrate, such as glucose gel, glucose tablets, or 4 oz of juice if allowed by unit policy. Then the nurse should recheck the blood glucose in 15 minutes. This matters because the first treatment may not be enough, and hypoglycemia can worsen quickly if not reassessed.

After the glucose improves, the nurse should make sure the patient gets a longer-acting carbohydrate or the delayed meal tray if available. That helps prevent the blood sugar from dropping again after the quick sugar wears off. The nurse should also identify the cause, which here is insulin given before food was actually present.

In practice, the nurse should assess and act in this order:

1. Recognize the symptoms of hypoglycemia: shakiness, sweating, pallor, confusion.
2. Check the blood glucose to confirm the problem.
3. Treat immediately with fast carbohydrate because the patient is conscious and can swallow.
4. Recheck in 15 minutes.
5. Repeat treatment if still below target per protocol.
6. Once stable, provide food and report the event according to policy.
7. Document the symptoms, glucose values, treatment, response, and likely cause.

The broader nursing lesson is important: do not give rapid-acting insulin unless the meal is actually ready and available. “On the way” is not the same as “at the bedside.” That small timing mistake can create a real safety issue.

Why the Other Options Are Wrong

B. Document the findings and notify the provider that the lunch tray is delayed

This delays treatment. The patient already has a blood glucose of 58 mg/dL and symptoms. Nursing action comes first. The provider can be notified after the nurse treats the immediate problem and reassesses the patient. NCLEX priority questions often test whether you can separate urgent bedside care from secondary communication tasks.

C. Give the scheduled lunchtime insulin dose again once the meal tray arrives

This is unsafe. The patient already received the lispro dose at 1145. Giving more insulin would worsen the hypoglycemia. The nurse should instead treat the low blood glucose, confirm recovery, and then ensure food intake. If there is any confusion about whether a dose was given, the nurse should verify the medication administration record, not guess.

D. Place the patient flat in bed and apply oxygen at 2 L/min by nasal cannula

This does not treat the actual problem. Oxygen is not the first intervention for insulin-related hypoglycemia in a conscious patient with a low glucose reading. Positioning and oxygen may be appropriate in other situations, such as respiratory distress or syncope, but here the direct cause of the symptoms is low blood sugar. Treat the cause, not just the appearance of illness.

Key Takeaways

• Rapid-acting insulin can cause hypoglycemia quickly if food is delayed.
• Symptoms like shakiness, sweating, confusion, and pallor should prompt an immediate glucose check.
• If the patient is awake and can swallow, give 15 g of rapid-acting carbohydrate.
• Recheck blood glucose in 15 minutes. Reassessment is part of the treatment.
• After recovery, give a meal or longer-acting carbohydrate to prevent another drop.
• For safety, give rapid-acting insulin when the tray is present, not just expected.

What you’d do on shift:

• Confirm the patient can swallow safely.
• Give fast carbohydrate right away.
• Recheck glucose in 15 minutes.
• Repeat per protocol if still low.
• Get the meal to the patient once stable.
• Report the event and document the full response.
• Change your workflow so rapid-acting insulin is tied to meal arrival.

Quick Practice Extension

1. If this same patient were drowsy and unable to swallow safely, what would the nurse do next?

2. What change in nursing practice would best prevent this type of insulin-related event from happening again on a busy shift?

NCLEX Question of the Day – Friday, April 24, 2026

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