A patient on NPH insulin is NPO for a blood draw at 10 AM, with NPH ordered at 7 AM. The nurse should:

• A. Give the insulin as ordered.
• B. Give the insulin with a small snack
• C. Inform the charge nurse.
• D. Hold the insulin until after the blood draw.

Answer: (D)

When a patient is NPO for a procedure, you must align insulin administration with the lack of oral intake. NPH is an intermediate-acting insulin, and giving it at 7 AM while no carbohydrates are being eaten can push the blood glucose down during the fasting period. By 10 AM, the patient’s glucose could drop into hypoglycemia, especially since there’s no meal to balance the insulin’s effect. Therefore, the safest course is to hold the NPH until after the blood draw, then reassess the patient’s glucose and resume or adjust insulin per protocol.

Giving with a snack isn’t appropriate for an NPO patient, and simply notifying the charge nurse doesn’t address the immediate safety concern. Holding the insulin minimizes hypoglycemia risk during fasting and allows for proper glucose monitoring and adjustment after the procedure.