Editing Medical-Surgical Nursing – RN Practice Questions (section)

==Question 6==
A patient in diabetic ketoacidosis has a blood glucose of 486 mg/dL, arterial pH of 7.14, and serum potassium of 3.1 mEq/L. The provider orders an intravenous regular insulin infusion. What is the nurse's most appropriate action?
# Begin the insulin infusion as ordered and recheck potassium in four hours.
# Hold the insulin infusion, notify the provider, and anticipate potassium replacement first.
# Give the insulin subcutaneously instead to slow the rate of glucose reduction.
# Administer sodium bicarbonate before starting the insulin infusion.

'''Answer:''' Option 2, hold the insulin infusion, notify the provider, and anticipate potassium replacement first.

''Rationale:'' Insulin drives potassium from the extracellular space into cells. Starting insulin when the serum potassium is already below approximately 3.3 mEq/L can precipitate profound hypokalemia with lethal dysrhythmias and respiratory muscle weakness. Potassium is replaced first and the infusion is then started. Option 1 exposes the patient to that risk. Option 3 is inappropriate because intravenous regular insulin is the standard route in ketoacidosis and the route change does not address the potassium problem. Option 4 is not routine and is reserved for severe acidosis under specific circumstances.