Editing Pharmacology – RN Practice Questions (section)

==Question 7==
A client in diabetic ketoacidosis is receiving a regular insulin infusion at 7 units per hour and 0.9 percent sodium chloride. The point-of-care glucose has fallen from 620 mg/dL to 245 mg/dL, and the anion gap remains elevated with ketones still present. Which action should the nurse anticipate?
# Stopping the insulin infusion immediately
# Adding dextrose to the intravenous fluid and continuing the insulin infusion
# Switching to subcutaneous insulin glargine and stopping all intravenous fluids
# Doubling the insulin infusion rate to clear the ketones faster

'''Answer:''' 2 (B) Adding dextrose to the intravenous fluid and continuing the insulin infusion.

''Rationale:'' In diabetic ketoacidosis the endpoint of insulin therapy is closure of the anion gap and clearance of ketosis, not normalization of glucose. When the glucose falls to roughly 200 to 250 mg/dL, dextrose is added to the fluid so that the insulin infusion can continue safely without producing hypoglycemia. Option 1 would allow ketogenesis to resume. Option 3 is premature; the transition to subcutaneous insulin occurs after the gap closes, and overlap with the infusion is required. Option 4 risks hypoglycemia and hypokalemia without benefit.