Which of these complications of insulin therapy is characterized by a rapid decrease in serum glucose, usually at night, causing the release of glucose-elevating hormones and an elevated glucose level in the morning, which may be inadvertently treated with an increased insulin dose?

Choice A rationale: An external insulin pump is a device designed to mimic the normal function of the pancreas. It provides a continuous, basal infusion of rapid-acting or regular insulin subcutaneously to maintain a steady blood glucose level. The client can then manually administer a bolus dose before meals to cover the carbohydrate intake, providing greater flexibility and precise glucose management.
Choice B rationale: Insulin pumps use rapid-acting or regular insulin, not NPH insulin. NPH is an intermediate-acting insulin, and its delayed and prolonged action is not suitable for the precise, continuous, and meal-time dosing regimen of an insulin pump. Pumps require fast-acting insulin to manage immediate glucose fluctuations.
Choice C rationale: Insulin pumps are external devices and are not surgically attached to the pancreas. They are worn on the body and deliver insulin into the subcutaneous tissue through a small catheter. The pancreas is an internal organ, and this type of surgical intervention is not a feature of standard insulin pump therapy.
Choice D rationale: The pump uses rapid-acting or regular insulin, not NPH insulin. While it does provide a continuous infusion, the client still needs to manually monitor their blood glucose levels and adjust their bolus doses accordingly. The pump itself does not continuously monitor blood glucose levels without an integrated continuous glucose monitor (CGM) system, which is a separate but often used device.

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.