A patient with diabetic ketoacidosis (DKA) has been receiving insulin for 6 hours. Laboratory finding are Na+ 131, K+ 3.7, CL- 102, HCO3 22, and glucose 170. Which action should the nurse take?
Give potassium intravenously.
Administer D5 NS with the insulin drip.
Administer 3% NS at 200ml/hr
Expect the insulin drip to be discontinued.
The Correct Answer is B
A. Give potassium intravenously. – The potassium level is 3.7 (within normal range 3.5–5.0), so potassium is not needed yet.
B. Administer D5 NS with the insulin drip. – Correct Answer. Once glucose drops to ≤200 mg/dL, dextrose is added to prevent hypoglycemia while continuing insulin to correct ketoacidosis.
C. Administer 3% NS at 200 mL/hr. – Hypertonic saline is used for severe hyponatremia, which is not the case here.
D. Expect the insulin drip to be discontinued. – The insulin drip is not discontinued until ketoacidosis has fully resolved (when HCO3 > 18, pH > 7.3, and anion gap normalizes).
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Related Questions
Correct Answer is D
Explanation
A. High fever. – Incorrect. Fever can occur with infection but is not a hallmark sign of sickle cell crisis.
B. Constipation. – Incorrect. Constipation is not a defining symptom of sickle cell crisis.
C. Bradycardia. – Incorrect. Tachycardia, not bradycardia, is common due to pain and hypoxia.
D. Pain. – Correct Answer. Severe pain is the most common symptom of sickle cell crisis due to vaso-occlusion and ischemia.
Correct Answer is C
Explanation
A. Clarify the prescription because the insulin should not be administered at this time. – Incorrect. Aspart insulin is rapid-acting and should be given with meals to prevent post-meal hyperglycemia.
B. Hold breakfast for one hour after the insulin administration. – Incorrect. Rapid-acting insulin peaks quickly (within 30-90 minutes), so delaying food increases the risk of hypoglycemia.
C. Administer insulin when breakfast arrives. – Correct Answer. Aspart insulin should be given right before or with food to match glucose absorption and prevent hypoglycemia.
D. Check the blood glucose immediately after breakfast. – Incorrect. Blood glucose should be checked before insulin administration to ensure appropriate dosing.
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