A client is a Type 1 diabetic and is hospitalized for wound on the right foot. The MAR states: NPH Insulin 40 Units Subcutaneously at 0800 and 1600 Sliding Scale Regular Insulin Subcutaneously ac and hs (0700, 1100, 1600 and 2200) Blood Glucose Levels AC Dose HS Dose BG 100 AC 0 Units HS 0 Units BG 101-150 AC 2 Units HS 0 Units BG 151-200 AC 4 Units HS 2 Units BG 201-250 AC 6 Units HS 4 Units The client’s pre-lunch blood glucose is 180 mg/dL. Which insulin doses should the nurse administer at 1100?

Rationale: A. The nurse administers NPH 40 Units and Regular Insulin 12 Units: Administering 12 units of sliding-scale insulin would exceed the prescribed sliding-scale dose for a pre-lunch blood glucose of 180 mg/dL, which is 4 units. Overdosing could cause hypoglycemia. B. The nurse administers NPH 40 Units: NPH insulin is scheduled for 0800 and 1600 and is not typically repeated at 1100. Administering only NPH at 1100 would not address the elevated pre-lunch blood glucose or follow the sliding-scale protocol. C. The nurse administers NPH 40 Units and Regular Insulin 4 Units: The NPH 40 units is part of the scheduled 0800 dose, and the sliding-scale regular insulin dose for a pre-lunch blood glucose of 180 mg/dL is 4 units. Administering both ensures basal coverage from NPH and correctional coverage from regular insulin according to the MAR. D. NPH 40 Units and regular insulin 2 units: The sliding-scale protocol specifies 4 units of regular insulin for a blood glucose between 151–200 mg/dL. Administering only 2 units would underdose the client and may leave hyperglycemia inadequately corrected.