NCLEX Answer: Blood Sugar 58
The question: A client with type 1 diabetes is awake and alert and says they feel shaky. The fingerstick blood glucose is 58 mg/dL. Lunch trays arrive in 30 minutes. What should the nurse do first?
A) Give the scheduled insulin with lunch
B) Give 15 g of fast-acting carbohydrate and recheck in 15 minutes
C) Call the provider before doing anything
D) Give IV dextrose
✅ The answer is B) Give 15 g of fast-acting carbohydrate and recheck in 15 minutes
A blood glucose under 70 mg/dL is hypoglycemia. For a client who is awake and can swallow, the first step is 15 g of fast-acting carbohydrate, like 4 oz of juice or regular soda, then a recheck in 15 minutes. That's the 15-15 rule.
How to decode it with my S.M.A.R.T. framework
- Scan for the clue: a glucose of 58 mg/dL, and the client is “awake and alert.”
- Match it to context: 58 is low, so this is hypoglycemia, and an awake client can safely swallow.
- Analyze the opposites: insulin lowers blood sugar, the opposite of what this client needs right now.
- Rule out distractors: A drops the glucose even lower. C delays treatment for a problem you can fix right now. D is for a client who can't swallow safely or is unconscious, and this client is awake.
- Target the best answer: B) Give 15 g of fast-acting carbohydrate and recheck in 15 minutes.
Two words decided this question: “awake and alert.” Change them to “unresponsive” and the answer moves to IV dextrose or glucagon. Same number, different client, different answer. That's content plus strategy, and you need both to pass the NCLEX.
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