The client is receiving total parental nutrition (TPN). Which prescription would the nurse administer if it is 0730? Client: M.G. MR# 1234567 Date: Today Age: 35 years Allergies: NKDA Diagnosis: Medication 0701-1900 1901-0700 Sliding-scale regular insulin <150 no coverage 151-2004 units 151–200 mg/dL → 4 units 201–250 mg/dL → 6 units 251–300 mg/dL → 8 units >300 mg/dL → 10 units 0730 Blood glucose 311

Insulin dosing using a sliding-scale regimen is commonly used in patients receiving total parenteral nutrition (TPN) to manage hyperglycemia caused by high dextrose infusion. Blood glucose levels are monitored closely, and insulin is administered based on predefined ranges to maintain glycemic control. The client has significant hyperglycemia requiring the highest correction dose according to the protocol. Accurate interpretation of sliding-scale orders is essential to prevent complications such as osmotic diuresis and electrolyte imbalance. A. A blood glucose level of 311 mg/dL falls within the “greater than 300 mg/dL” range on the sliding-scale protocol, which indicates administration of 10 units of regular insulin. This is the highest correction dose in the order set and is appropriate for severe hyperglycemia. Prompt insulin administration is critical in patients receiving TPN to prevent metabolic complications such as ketoacidosis or hyperosmolar states. B. Administering 4 units of regular insulin corresponds to the 151–200 mg/dL range, which is significantly lower than the client’s current blood glucose level. Giving this dose would result in under-treatment of hyperglycemia, allowing persistently elevated glucose levels. Inadequate insulin coverage in TPN patients can lead to poor metabolic control and increased risk of infection and delayed healing. C. Administering 8 units of regular insulin corresponds to a glucose range of 251–300 mg/dL. Although closer, the client’s reading of 311 mg/dL exceeds this range, requiring a higher correction dose. Using this dose would result in insufficient glycemic correction and continued hyperglycemia despite treatment. D. Administering 6 units of regular insulin is indicated for blood glucose levels between 201–250 mg/dL. This dose is not appropriate for the current reading of 311 mg/dL. Selecting a lower dose than indicated would fail to adequately reduce serum glucose and may increase the risk of TPN-related metabolic complications.