A client presents with diaphoresis, palpitations, nervousness, and tachycardia approximately 4 hours after taking his usual morning insulin. Which treatment is appropriate for this client?

Choice A rationale: Glucose is a primary fuel source, but the body can also use fatty acids and amino acids for energy through metabolic pathways like beta-oxidation and gluconeogenesis. The brain, however, has a high metabolic rate and is highly dependent on glucose as its main energy substrate because fatty acids cannot cross the blood-brain barrier efficiently.
Choice B rationale: The brain is almost exclusively dependent on glucose for its energy needs, as it lacks the ability to store glucose as glycogen and cannot effectively utilize other energy sources like fatty acids. A sustained blood glucose level below the normal range, typically below 60 mg/dL, impairs cerebral function, leading to symptoms like confusion and lethargy.
Choice C rationale: The production of red blood cells, a process called erythropoiesis, occurs primarily in the bone marrow. This process is regulated by the hormone erythropoietin and depends on nutrients like iron, vitamin B12, and folic acid. It is not directly linked to a minimum blood glucose level in the way that brain function is.
Choice D rationale: Lactic acid is produced during anaerobic metabolism when oxygen supply is insufficient, not due to low blood glucose. While severe hypoglycemia can lead to metabolic disturbances, lactic acidosis is typically associated with conditions like shock or certain metabolic disorders, not directly with low blood glucose levels.

Choice A rationale: Administering half the dose of an oral antidiabetic medication without food can still cause hypoglycemia. The patient is NPO, meaning their body is not receiving any glucose from food intake. Oral antidiabetic drugs lower blood glucose. Even a reduced dose could precipitate a hypoglycemic episode, which is particularly dangerous in a hospitalized patient undergoing a procedure.
Choice B rationale: Withholding all medications as ordered is not always the correct action without a specific order. While withholding the medication is likely the correct course of action for an NPO patient, a nurse should always follow a prescriber's explicit orders. A nurse should not withhold medications independently, especially when the patient is on a scheduled medication regimen, as this could lead to unintended consequences.
Choice C rationale: The nurse should contact the prescriber for orders to clarify the patient's medication regimen. Patients who are NPO should not take oral medications that can cause hypoglycemia without a food source. Therefore, a new order is needed to either withhold the medication or adjust the dose based on the patient's fasting status and blood glucose levels, ensuring patient safety.
Choice D rationale: Giving the medication with a sip of water is dangerous because it provides no nutritional support to counteract the medication's glucose-lowering effects. Since the patient is NPO, they are not consuming food, and the medication could cause a severe hypoglycemic event. Additionally, taking anything by mouth may violate the NPO status required for the endoscopy, compromising the procedure.