A hospitalized patient with diabetic mellitus 2 is found to have a random blood sugar (RBS) of 48 mg/dL. The patient is conscious, oriented, and able to swallow. What is the first step in management?

1. A

   Start IV 50% dextrose immediately

2. B

   Give oral Carbohydrate tablet

3. C

   Administer insulin

4. D

   Wait and repeat RBS after 1 hour

Appeared in: NORCET 10 Prelims-2026

Explanation

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• The patient's blood sugar of 48 mg/dL is below the hypoglycemic threshold of 70 mg/dL, requiring immediate intervention.
• Since the patient is conscious, alert, and able to swallow, the safest and most effective initial treatment is the oral administration of fast-acting carbohydrates.
• This approach aligns with the "Rule of 15," a standard protocol for managing mild to moderate hypoglycemia.
• Oral treatment is less invasive and preferred over parenteral routes when the patient can safely swallow.

Why Other Options Were Wrong

• Option A: This is an intervention for severe hypoglycemia. It is unnecessarily invasive for a conscious and alert patient who can swallow.
• Option C: This is dangerous and strictly contraindicated. Insulin lowers blood glucose and would severely worsen the patient's hypoglycemia, potentially leading to coma or death.
• Option D: Hypoglycemia is a medical emergency that requires immediate action. Delaying treatment can lead to a rapid deterioration, including loss of consciousness, seizures, and permanent brain damage.

Related Visual

• Visual 1: Flowchart: Management of Hypoglycemia in Adults - A visual guide showing the decision-making process based on the patient's level of consciousness and blood glucose level.
• Visual 2: Infographic: The Rule of 15 - A simple graphic explaining how to treat mild hypoglycemia with 15g of carbs, waiting 15 minutes, and rechecking.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Management of mild to moderate hypoglycemia in a conscious adult in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Prompt recognition and treatment of hypoglycemia are critical nursing responsibilities to prevent severe neurological complications and ensure patient safety.
• Nurses must be able to differentiate between mild/moderate and severe hypoglycemia to apply the correct treatment protocol, avoiding unnecessarily invasive procedures while acting swiftly.
• What if the patient's RBS was 48 mg/dL but they were drowsy and their ability to swallow was questionable? The nurse's priority would shift to safety. To prevent aspiration, parenteral treatment (IV dextrose or IM glucagon) would become the safer first-line intervention.

How to Approach the Question

• First, identify the core clinical problem from the data provided: the RBS of 48 mg/dL indicates hypoglycemia.
• Next, assess the patient's status using the descriptive keywords: 'conscious, oriented, and able to swallow'. These are the most critical factors for determining the intervention.
• Evaluate each option based on the patient's status. The ability to swallow safely is the key differentiator between oral and parenteral treatment routes.
• Systematically eliminate options that are clearly incorrect or dangerous. Administering insulin is contraindicated, and waiting is a harmful delay.
• Select the intervention that is safest, least invasive, and most appropriate for a conscious, stable patient, which is the administration of oral carbohydrates.

Concept Tested & Keywords

• Concept Tested: Management of mild to moderate hypoglycemia in a conscious adult.
• Stem keywords: diabetic mellitus 2, random blood sugar (RBS) of 48 mg/dL, conscious, oriented, able to swallow, first step
• Lead-in keywords: first step
• Clinical cues: RBS 48 mg/dL indicates hypoglycemia (less than 70 mg/dL).
• Clinical cues: Patient is conscious and can swallow, which dictates the route of administration.

Question ID

Q5Pq6YFlbBv1DDT6x7iHci

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