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Difficulty: HardPharmacological Therapies

A client with a history of type 2 diabetes mellitus activates the call light at 07:15. Upon entering the room, the practical nurse observes that the client is fully conscious but visibly diaphoretic and experiencing hand tremors. A point-of-care capillary blood glucose test reveals a level of 5858 mg/dL (3.23.2 mmol/L). A scheduled dose of oral glipizide is due at 07:30. Which action should the practical nurse take next?

  1. Withhold the glipizide, provide 1515 grams of a fast-acting oral carbohydrate, and alert the registered nurse.Answer
  2. B
    Administer the scheduled glipizide and ensure the client promptly eats their entire morning breakfast tray.
  3. C
    Administer a prescribed as-needed dose of intravenous 50%50\% dextrose to rapidly stabilize the glucose level.
  4. D
    Deliver the scheduled glipizide immediately without using the barcode scanner to prevent any further delays.

Answer

Withhold the glipizide, provide 15 grams of a fast-acting oral carbohydrate, and alert the registered nurse.
The client is experiencing symptomatic hypoglycemia (blood glucose less than 70 mg/dL). Because the client is fully conscious and able to swallow, the safest and most appropriate immediate action is to provide 15 grams of a fast-acting oral carbohydrate (such as 4 ounces of fruit juice). The practical nurse must withhold the glipizide, as its mechanism of action is to stimulate insulin release, which would further lower the blood glucose level. After initiating treatment, the practical nurse must promptly report the client's condition to the registered nurse for further evaluation.

Step-by-Step Solution

1
Analyze the client's assessment data.
The client has a blood glucose level of 58 mg/dL and is exhibiting diaphoresis and tremors.
Identifying the clinical signs and laboratory confirmation of hypoglycemia is required to determine the appropriate intervention.
2
Evaluate the scheduled medication.
Glipizide is a sulfonylurea that stimulates insulin secretion and lowers blood glucose.
Understanding the medication's mechanism reveals that administering it would dangerously exacerbate the hypoglycemia.
3
Determine the practical nurse's scope of practice and prioritize actions.
The nurse must provide an oral carbohydrate (since the client is conscious), withhold the contraindicated medication, and escalate the critical findings to the RN.
This sequence ensures immediate patient safety, adheres to the LPN/LVN scope of practice, and maintains effective interdisciplinary communication.

Key Concept

Management of hypoglycemia and practical nurse scope of practice in medication administration
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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