A client newly diagnosed with diabetes mellitus suddenly becomes confused and weak. Which intervention(s) should the nurse implement? Select all that apply.
Explanation & Rationale
A. Provide the client with 1/2 cup (120 mL) diet carbonated soda: Diet soda contains artificial sweeteners and no sugar, so it will not raise blood glucose and is not appropriate for treating hypoglycemia symptoms. B. Check the client's current fingerstick blood glucose: Confusion and weakness may indicate hypoglycemia, so verifying the client’s glucose level is a critical first step to determine the appropriate treatment. C. Obtain blood pressure and heart rate: Vital signs help assess the client’s overall stability and may reveal signs of autonomic response to hypoglycemia or another underlying issue requiring intervention. D. Administer a PRN dose of regular insulin: Giving insulin could dangerously lower the client’s blood glucose further if hypoglycemia is present; insulin should not be given without first confirming hyperglycemia. E. Give the client 4 ounces (120 mL) of orange juice: If hypoglycemia is suspected, giving a fast-acting carbohydrate like orange juice is appropriate to rapidly raise blood glucose and relieve symptoms.