A female client with type 1 diabetes mellitus, receives a dose of insulin lispro SUBQ per sliding scale at 0800 because her fingerstick serum glucose was 180 mg/dl (10.0 mmol/L). At 1000, after eating 25% of her breakfast, she reports having a headache, nervousness, tremors, and is perspiring. Which action should the nurse take first? Reference range: Blood glucose [Casual/non-fasting: Less than or equal to 200 mg/dL (less than 11.1 mmol/L)]

Rationale: A. Notify the healthcare provider and prepare IV insulin for diabetic ketoacidosis: The client’s symptoms are consistent with hypoglycemia, not diabetic ketoacidosis. DKA usually presents with hyperglycemia, polyuria, fruity breath, and Kussmaul respirations. B. Administer another dose of insulin lispro and provide an early lunch: Giving additional insulin would worsen the client’s hypoglycemia. Since the client already received insulin at 0800 and ate only 25% of breakfast, further insulin without checking glucose would be unsafe and potentially life-threatening. C. Reassess the fingerstick glucose level and bring orange juice to the bedside: The client’s symptoms strongly suggest hypoglycemia following rapid-acting insulin administration. The safest immediate action is to check the glucose level while also preparing to administer a fast-acting carbohydrate like orange juice. D. Obtain current vital signs and initiate venous access for isotonic fluid replacement: Establishing IV access and fluids may be useful if the client becomes severely unstable. However, the immediate priority is to confirm and treat hypoglycemia.