The wife of a client with diabetes mellitus who uses insulin reports the patient is sleepy with warm, flushed skin, faster breathing, and a rapid pulse. What action should the nurse tell the wife to do first?

• A. Drive him to the health care provider's office.
• B. Call an ambulance.
• C. Take his temperature.
• D. Check his blood glucose level.

Answer: (D)

In this situation the immediate goal is to determine the current glucose level. For someone with diabetes on insulin who becomes sleepy and has rapid breathing and a fast pulse, the most urgent and informative step is to check blood glucose right away. This measurement distinguishes hypoglycemia from other emergencies and guides the next treatment quickly. If the glucose is low, you know to give a fast-acting carbohydrate and recheck soon. If it’s normal or high, you proceed with appropriate measures and seek urgent care if the patient worsens. Temperature check or driving to a clinic wouldn’t address the immediate need, and calling an ambulance isn’t the first step unless the patient’s condition warrants emergency transport or the glucose cannot be checked.