A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next?

Choice A rationale: The initial administration of orange juice, a simple carbohydrate, is the correct first step for mild hypoglycemia. Since the client's symptoms have not resolved within five minutes, it is appropriate to administer another dose of 15 grams of a simple carbohydrate to raise blood glucose levels. A half-cup of orange juice provides approximately 15 grams of carbohydrates. Choice B rationale: Dextrose 50% IV is a hypertonic glucose solution administered for severe hypoglycemia when a client is unable to swallow or is unconscious. Since the client is awake and alert, they can safely ingest oral carbohydrates, and IV administration is not yet indicated. Choice C rationale: Administering insulin, which lowers blood glucose, would worsen the client's hypoglycemic state and is contraindicated. The client's symptoms of shakiness, diaphoresis, and weakness are classic signs of hypoglycemia, indicating a need for glucose, not insulin. Choice D rationale: Glucagon is a hormone that raises blood glucose by stimulating the liver to release stored glucose. It is typically used for severe hypoglycemia in unconscious clients or those who cannot receive oral glucose. Since the client is conscious, an oral carbohydrate is the preferred and safer option.