A nurse is caring for a client with a blood glucose of 42 mg/dL who is confused and diaphoretic. Which of the following are the priority nursing interventions?

Choice A rationale Encouraging increased oral fluid intake is an inappropriate intervention for a confused client with a blood glucose of 42 mg/dL. While fluids are important, the priority is to raise the blood glucose level immediately. Furthermore, confusion increases the risk of aspiration, making the oral route dangerous if the client cannot protect their airway. Simple water intake does nothing to address the underlying neuroglycopenia. Treatment must focus on rapidly delivering glucose through concentrated sources to restore brain function. Choice B rationale Emergency dialysis is used for life-threatening electrolyte imbalances, such as severe hyperkalemia, or for clearing specific toxins and managing end-stage renal disease. It has no role in the management of acute hypoglycemia. The client’s confusion and diaphoresis are caused by a lack of circulating glucose, not the buildup of uremic waste products. Preparing for dialysis would delay the life-saving administration of glucose and would be an irrelevant and potentially harmful diversion of medical resources. Choice C rationale Administering 50 percent dextrose (D50) intravenously is a priority intervention for a client who is symptomatic and has a blood glucose level as low as 42 mg/dL. Because the client is confused, oral glucose is unsafe due to the risk of aspiration. D50 provides a concentrated bolus of glucose that rapidly increases serum levels, providing the brain with the necessary fuel to regain consciousness and stop the neuroglycopenic symptoms. This is a standard emergency protocol for severe hypoglycemia. Choice D rationale Rechecking the blood glucose 15 minutes after an intervention is a critical step in the "15-15 rule" of hypoglycemia management. After administering a glucose source, the nurse must evaluate the effectiveness of the treatment to ensure the level is rising appropriately toward the normal range of 70 to 110 mg/dL. This allows for the timely administration of a second dose if the glucose remains low. Continuous monitoring is essential until the client is stable and their mental status clears. Choice E rationale Administering an IV insulin infusion is strictly contraindicated for a client with a blood glucose of 42 mg/dL. Insulin works by moving glucose from the bloodstream into the cells, which would further lower the serum glucose and could lead to seizures, permanent brain damage, or death. Insulin is used to treat hyperglycemia, not hypoglycemia. The goal in this scenario is to raise the glucose level, so any administration of insulin would be a fatal medical error in this context.