NCLEX Question of the Day – Tuesday, April 21, 2026

Today’s question targets Pharmacology, specifically safe insulin administration and early recognition of hypoglycemia. This matters in real nursing because insulin errors can harm a patient fast. Nurses need to connect symptoms, medication timing, and blood glucose trends so they can act before a mild problem becomes an emergency.

Clinical Scenario

A 58-year-old patient is admitted to a medical-surgical unit with community-acquired pneumonia and type 2 diabetes mellitus. The patient takes insulin at home and has had poor oral intake for the last 24 hours due to nausea and fatigue. At 0730, the nurse checks the blood glucose and finds it is 248 mg/dL. A prescription says to give insulin lispro 6 units subcutaneously with breakfast and insulin glargine 18 units subcutaneously every morning. Breakfast trays are delayed because of a kitchen issue.

At 0815, the patient tells the nurse, “I feel shaky and sweaty.” The patient appears pale and anxious. A repeat finger-stick glucose is 62 mg/dL.

The Question

What is the nurse’s priority action?

Answer Choices

1. Administer the scheduled insulin glargine now to prevent rebound hyperglycemia.
2. Give 15 g of rapid-acting carbohydrate and recheck the blood glucose in 15 minutes.
3. Notify the provider that the breakfast tray is delayed and request a change in insulin doses.
4. Encourage the patient to rest quietly and recheck the blood glucose in 1 hour.

Correct Answer

B. Give 15 g of rapid-acting carbohydrate and recheck the blood glucose in 15 minutes.

Detailed Rationale

This patient has symptomatic hypoglycemia. The signs are classic: shakiness, sweating, pallor, and anxiety, with a blood glucose of 62 mg/dL. The priority is not the original high glucose from earlier. The priority is the patient’s current condition.

Because the patient is awake and able to swallow, the nurse should use the standard first-line treatment for mild to moderate hypoglycemia: 15 g of rapid-acting carbohydrate. Examples include 4 oz of juice or glucose tablets based on the facility protocol. The reason is simple: rapid carbohydrate raises the blood glucose quickly and can stop symptoms before they worsen into confusion, seizure, or loss of consciousness.

After treating, the nurse should recheck the blood glucose in 15 minutes. This matters because one treatment may not be enough, especially if the patient received rapid-acting insulin without eating. If the glucose is still low, the nurse repeats treatment per protocol.

Next, the nurse should think through why this happened. Insulin lispro is rapid acting. It begins working quickly, so it should be given when food is available or the patient is about to eat. In this case, breakfast was delayed and the patient already had poor intake. That combination increases the risk for hypoglycemia.

After the immediate low blood sugar is corrected, the nurse should assess and act in a practical sequence:

• Confirm what insulin was already given and when.
• Assess the patient’s ability to swallow safely.
• Monitor for improving symptoms such as less sweating, less tremor, and better comfort.
• Recheck glucose in 15 minutes.
• Provide a longer-acting carbohydrate or meal once the glucose is stabilized, if appropriate.
• Review future insulin timing with meal delivery to prevent another episode.
• Document the event, treatment, response, and any provider notification required by policy.

The main nursing judgment here is recognizing that symptoms plus a low blood glucose reading require immediate treatment. Do not delay care to make phone calls or worry first about later hyperglycemia. Brain tissue depends on glucose. That is why hypoglycemia is treated promptly.

Why the Other Options Are Wrong

A. Administer the scheduled insulin glargine now to prevent rebound hyperglycemia.

This is unsafe as the first action. Even though glargine is a long-acting basal insulin and not the most likely cause of this immediate drop, giving insulin during active hypoglycemia does not address the urgent problem. The patient needs glucose now, not more insulin. The nurse handles the low blood sugar first, then reassesses the medication plan.

C. Notify the provider that the breakfast tray is delayed and request a change in insulin doses.

This may become appropriate after the patient is stabilized, but it is not the priority. Calling the provider does not treat the patient’s current neuroglycopenic risk. NCLEX priority questions often test whether the nurse can separate an important task from an urgent one. Treat first, then notify as needed.

D. Encourage the patient to rest quietly and recheck the blood glucose in 1 hour.

This delays treatment and puts the patient at risk. Hypoglycemia can worsen quickly. Rest does not correct low blood sugar. Waiting an hour could allow progression to confusion, decreased level of consciousness, seizure, or injury.

Key Takeaways

• Symptoms matter. If a patient is shaky, sweaty, pale, or confused, check glucose and act on the current result.
• If the patient is awake and can swallow, treat hypoglycemia with 15 g of rapid-acting carbohydrate.
• Recheck blood glucose in 15 minutes. Do not assume one treatment fixed the problem.
• Rapid-acting insulin and delayed meals are a common setup for hypoglycemia.
• Always match insulin timing to food availability when possible.

• What you’d do on shift: verify the glucose, treat immediately, reassess symptoms, recheck in 15 minutes, give follow-up food if appropriate, review insulin timing, and document clearly.

Quick Practice Extension

1. A patient becomes confused and drowsy after receiving insulin, and cannot swallow safely. What nursing action would come first?
2. A patient’s blood glucose rises before lunch after repeated morning lows. What medication-timing or meal-related factors would you review before assuming the insulin dose is too low?

Questions like this test more than memorization. They test whether you can spot the immediate safety risk and respond in order. In practice, strong nurses do not just know insulin names. They connect the medication, the meal, the symptoms, and the bedside action that protects the patient right now.

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