A patient with diabetes is found unresponsive in bed after receiving insulin. The patient is breathing normally but does not respond to voice. What should the nurse do first?
Correct answer: A. Check the airway and call for emergency assistance
- A. Check the airway and call for emergency assistance
- B. Give glucose gel inside the patient’s cheek
- C. Offer fruit juice through a drinking straw
- D. Leave the patient briefly to obtain a glucose meter
Explanation
An unresponsive patient requires an immediate airway and breathing assessment, with emergency assistance activated. Nothing should be placed in the mouth because the patient cannot swallow safely. Glucose treatment follows the immediate safety assessment and local emergency protocol.
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About Clinical Judgement and Prioritisation
Clinical judgement links assessment findings, nursing knowledge and patient responses to a safe decision. Coverage includes ABCDE assessment, recognising actual or potential instability, prioritising airway, breathing and circulation, using urgency and risk rather than routine order, reassessing after intervention, and distinguishing a nursing priority from a medical diagnosis or a task that can wait.
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