CH 53: Diabetic Ketoacidosis Flashcards by Cheetah Girl

A 19-year-old patient with type 1 diabetes is brought to the ED by his roommate, who reports that the patient has been vomiting for two days and appears increasingly lethargic. Labs show:
* Glucose: 550 mg/dL
* Serum ketones: Positive
* ABG: pH 7.21
Which of the following findings would most likely confirm the diagnosis of DKA?

A. Blood glucose over 600 mg/dL
B. Positive serum ketones, acidosis, and hyperglycemia
C. Hypoglycemia and metabolic alkalosis
D. Low hemoglobin A1C and decreased insulin production

B. Positive serum ketones, acidosis, and hyperglycemia

Rationale: DKA is characterized by hyperglycemia, ketosis (positive ketones), and metabolic acidosis (low pH). The glucose level, ketone presence, and pH level support this diagnosis. Option A is more indicative of HHS, and the others do not align with the classic triad of DKA.

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DKA is caused by a profound deficiency of ________.

insulin

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Which of the following mechanisms contributes to the development of acidosis in DKA?

A. Increased breakdown of carbohydrates
B. Accumulation of urea in the blood
C. Production of acidic ketone bodies from fat metabolism
D. Respiratory compensation due to lactic acidosis

C. Production of acidic ketone bodies from fat metabolism

Rationale: In DKA, the lack of insulin leads the body to break down fats for energy, producing ketones, which are acidic. This causes metabolic acidosis. Carbohydrates are not being broken down effectively due to insulin deficiency.

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T/F

DKA is most likely to occur in people with type 1 diabetes.

true

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A nurse is monitoring a patient with DKA who is being treated with IV fluids and insulin. Which laboratory value requires immediate intervention?

A. Serum potassium 5.1 mEq/L
B. Serum sodium 129 mEq/L
C. Serum phosphate 2.4 mg/dL
D. Serum potassium 2.9 mEq/L

D. Serum potassium 2.9 mEq/L

Rationale: A potassium level of 2.9 mEq/L is critically low and poses a risk for life-threatening cardiac arrhythmias. Insulin therapy drives potassium into cells, so potassium levels must be monitored and replaced as needed.

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Which of the following are common precipitating factors of DKA? (SATA)

A. Inadequate insulin dosage
B. Excessive carbohydrate intake
C. Severe infection
D. Undiagnosed type 1 diabetes
E. Overexercising

A. Inadequate insulin dosage
C. Severe infection
D. Undiagnosed type 1 diabetes

Rationale: DKA can be triggered by infection, inadequate insulin, or newly diagnosed type 1 DM. Overeating or overexercising alone does not typically cause DKA unless accompanied by other factors like insulin omission or illness.

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Why does glucose continue to rise in DKA despite the presence of hyperglycemia?

A. The liver increases glycogen storage
B. The kidneys reabsorb glucose more efficiently
C. Insulin deficiency promotes gluconeogenesis
D. Glucose is not being consumed due to hypometabolism

C. Insulin deficiency promotes gluconeogenesis

Rationale: In DKA, insulin deficiency promotes gluconeogenesis, which is the liver’s production of glucose from non-carbohydrate sources, such as amino acids, further increasing blood glucose.

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A 22-year-old female with type 1 DM presents with fruity breath, deep rapid respirations, and confusion. Which acid-base imbalance is most likely?

A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis

A. Metabolic acidosis

Rationale: The fruity breath and Kussmaul respirations (deep, rapid breathing) are signs of metabolic acidosis due to excess ketone bodies in DKA.

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What is the body’s primary compensatory mechanism in response to the metabolic acidosis seen in DKA?

A. Decreased respiratory rate
B. Hyperventilation to blow off CO₂
C. Renal excretion of bicarbonate
D. Increased insulin secretion

B. Hyperventilation to blow off CO₂

Rationale: The body compensates for metabolic acidosis by increasing the respiratory rate (Kussmaul breathing) to reduce CO₂ and raise blood pH.

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A nurse is caring for a DKA patient with severe dehydration and hypotension. Which of the following interventions should the nurse prioritize first?

A. Administer IV regular insulin
B. Draw blood for blood glucose levels
C. Begin fluid resuscitation with 0.9% normal saline
D. Administer sodium bicarbonate IV

C. Begin fluid resuscitation with 0.9% normal saline

Rationale: Fluid resuscitation is the first priority to correct hypovolemia and restore perfusion before initiating insulin therapy. Insulin without fluids could worsen hypotension and hypokalemia.

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Which electrolyte imbalance is the most common and dangerous complication during the treatment of DKA?

A. Hypokalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypochloremia

A. Hypokalemia

Rationale: Hypokalemia is a serious risk during insulin therapy because insulin drives potassium into cells, lowering serum levels. This can lead to cardiac arrhythmias.

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What is the cause of dehydration in patients with DKA?

A. Decreased thirst sensation
B. Decreased renal perfusion
C. Osmotic diuresis from hyperglycemia
D. Excessive vomiting from lactic acidosis

C. Osmotic diuresis from hyperglycemia

Rationale: In DKA, excess glucose spills into the urine, drawing water with it (osmotic diuresis), leading to significant dehydration.

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Which of the following clinical manifestations are expected in a patient with DKA? (SATA)

A. Bradycardia
B. Kussmaul respirations
C. Fruity-scented breath
D. Hypoglycemia
E. Abdominal pain

B. Kussmaul respirations
C. Fruity-scented breath
E. Abdominal pain

Rationale: Kussmaul respirations, fruity breath (due to acetone), and abdominal pain are hallmark signs of DKA. Hypoglycemia is not present—hyperglycemia is.

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A patient with DKA has serum glucose of 600 mg/dL. The provider orders IV insulin. Which concurrent action must the nurse take?

A. Administer sodium bicarbonate
B. Monitor for signs of infection
C. Start potassium replacement even if levels are normal
D. Begin fluid restriction to prevent cerebral edema

C. Start potassium replacement even if levels are normal

Rationale: As insulin therapy begins, potassium levels drop rapidly. Even if potassium is normal initially, it must be monitored closely and replaced to avoid hypokalemia.

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What is the primary reason untreated DKA can lead to coma or death?

A. Liver failure and lactic acidosis
B. Hyperglycemia-induced vasoconstriction
C. Dehydration, electrolyte imbalance, and metabolic acidosis
D. Pancreatic necrosis

C. Dehydration, electrolyte imbalance, and metabolic acidosis

Rationale: The combination of severe dehydration, acidosis, and electrolyte disturbances can impair cerebral perfusion, leading to coma or death if not corrected.

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In a patient with DKA and newly diagnosed type 1 DM, the nurse understands the root cause of their condition is:

A. Excessive intake of sugary foods
B. A deficiency of insulin production
C. Resistance to insulin at the receptor level
D. Chronic liver disease

B. A deficiency of insulin production

Rationale: Type 1 diabetes is an autoimmune condition that results in a near or total lack of insulin production, which directly leads to DKA if not managed.

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During DKA, the kidneys excrete ketones in the urine along with which of the following?

A. Uric acid
B. Cation electrolytes like potassium and sodium
C. Bicarbonate
D. Protein-bound calcium

B. Cation electrolytes like potassium and sodium

Rationale: Ketones are excreted in the urine with cation electrolytes such as potassium and sodium to maintain ionic balance, contributing to electrolyte depletion.

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A 17-year-old male with a history of insulin non-compliance presents with confusion, dry mucous membranes, and a glucose level of 700 mg/dL. The nurse knows this condition could lead to:

A. Increased protein synthesis
B. Respiratory depression
C. Bradycardia and cardiac tamponade
D. Hypovolemic shock and renal failure

D. Hypovolemic shock and renal failure

Rationale: If left untreated, DKA leads to progressive dehydration, hypovolemia, and possible renal failure due to reduced perfusion. Prompt treatment is essential.

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Why does vomiting exacerbate DKA?

A. It reduces insulin resistance
B. It increases blood glucose levels directly
C. It neutralizes acidic ketone bodies
D. It contributes to further fluid and electrolyte loss

D. It contributes to further fluid and electrolyte loss

Rationale: Vomiting leads to additional fluid and electrolyte loss, worsening the hypovolemia and electrolyte imbalances already present in DKA.

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A 16-year-old girl with type 1 diabetes is brought to the emergency department. Her mother reports she’s been weak and nauseated for two days and has had minimal fluid intake.
On assessment, the nurse notes dry mucous membranes, a blood pressure of 92/58 mmHg when sitting, and 80/50 mmHg when standing, along with a heart rate of 118 bpm.
What is the most likely cause of her vital signs?

A. Fluid volume deficit related to dehydration
B. Autonomic nervous system dysfunction
C. Insulin overdose
D. Diabetic neuropathy

A. Fluid volume deficit related to dehydration

Rationale: Orthostatic hypotension, tachycardia, and dry mucous membranes are classic signs of fluid volume deficit due to dehydration from osmotic diuresis in DKA.

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A nurse is caring for a patient in DKA. Which of the following clinical findings would the nurse expect to assess?

A. Bradycardia and respiratory depression
B. Cool, clammy skin and pinpoint pupils
C. Warm, moist skin and constricted pupils
D. Dry, loose skin and sunken eyes

D. Dry, loose skin and sunken eyes

Rationale: DKA results in severe dehydration, which manifests as dry, loose skin and soft, sunken eyes. Other options describe symptoms not consistent with DKA.

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Which respiratory pattern is most indicative of the body’s attempt to correct the metabolic acidosis in a patient with DKA?

A. Cheyne-Stokes breathing
B. Kussmaul respirations
C. Apneustic breathing
D. Bradypnea

B. Kussmaul respirations

Rationale: Kussmaul respirations are deep and rapid, the body’s compensatory mechanism to blow off excess CO₂ and correct the low pH of metabolic acidosis.

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A 23-year-old with undiagnosed type 1 diabetes presents to the ED with nausea, vomiting, abdominal pain, and fruity-smelling breath. Labs reveal:
* Glucose: 475 mg/dL
* pH: 7.25
* Serum bicarbonate: 14 mEq/L
* Positive serum ketones
Which of the following would the nurse prioritize as the next step?

A. Administer oral hypoglycemics
B. Monitor for signs of cerebral edema
C. Initiate IV fluids and insulin therapy
D. Schedule the patient for dialysis

C. Initiate IV fluids and insulin therapy

Rationale: The patient meets the criteria for DKA. Immediate fluid resuscitation and insulin therapy are the priorities to correct dehydration and hyperglycemia.

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Which symptom should the nurse interpret as an early neurological sign of DKA?

A. Coma
B. Seizures
C. Lethargy
D. Muscle rigidity

C. Lethargy

Rationale: Lethargy and weakness are among the earliest neurological symptoms due to cellular dehydration and acidosis affecting the brain in DKA.

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Which of the following clinical manifestations are commonly seen in patients with DKA? (SATA) A. Abdominal pain B. Fruity breath odor C. Hypoglycemia D. Dry mucous membranes E. Cool, moist skin

A. Abdominal pain B. Fruity breath odor D. Dry mucous membranes Rationale: Abdominal pain, fruity (acetone) breath, and dry mucous membranes are characteristic signs of DKA. Hypoglycemia and cool skin are not.

A nurse assesses a patient with suspected DKA. The patient is alert but weak and has a fruity breath odor and deep, rapid breathing. Which ABG value supports the nurse’s suspicion? A. pH 7.45, HCO₃ 26 mEq/L B. pH 7.28, HCO₃ 14 mEq/L C. pH 7.50, HCO₃ 30 mEq/L D. pH 7.34, HCO₃ 24 mEq/L

B. pH 7.28, HCO₃ 14 mEq/L Rationale: A pH below 7.30 and bicarbonate below 16 mEq/L are diagnostic of metabolic acidosis, confirming the presence of DKA.

The nurse understands that fruity breath in a patient with DKA is caused by: A. Accumulation of acetone due to fat metabolism B. Lactic acid buildup in the bloodstream C. Gastrointestinal bleeding D. Bacterial overgrowth in the oral cavity

A. Accumulation of acetone due to fat metabolism Rationale: In the absence of insulin, the body breaks down fat, producing ketone bodies. Acetone, a volatile ketone, is exhaled and gives the breath a fruity odor.

During triage, which of the following patients would the nurse suspect to be in DKA? A. A 40-year-old type 2 diabetic with a blood glucose of 180 mg/dL and cool, clammy skin B. A 29-year-old type 1 diabetic with dry mucous membranes, abdominal pain, and blood glucose of 410 mg/dL C. A 55-year-old patient with nausea and vomiting, BP 150/95, and blood glucose 140 mg/dL D. A 34-year-old with rapid breathing and pinpoint pupils after using opioids

B. A 29-year-old type 1 diabetic with dry mucous membranes, abdominal pain, and blood glucose of 410 mg/dL Rationale: This patient exhibits textbook signs of DKA: hyperglycemia, dehydration, abdominal pain, and likely ketone production, warranting immediate further evaluation and intervention.

A 19-year-old with type 1 diabetes presents to the ED with DKA. She has a blood pressure of 84/52 mmHg, dry mucous membranes, and a heart rate of 122 bpm. What is the priority nursing action? A. Administer a bolus of IV insulin B. Begin IV fluid replacement C. Administer potassium chloride D. Apply a cardiac monitor

B. Begin IV fluid replacement Rationale: Fluid replacement is the priority in DKA, especially in hypotensive patients, to restore intravascular volume and perfusion before starting insulin.

A patient with DKA has a serum potassium level of 3.0 mEq/L. What is the most appropriate action before initiating insulin therapy? A. Begin insulin infusion and monitor ECG B. Start potassium replacement C. Restrict fluids to prevent dilutional hyponatremia D. Administer sodium bicarbonate

B. Start potassium replacement Rationale: Insulin drives potassium into cells, which can worsen existing hypokalemia and lead to dangerous arrhythmias. Potassium must be replaced before insulin therapy begins.

Which IV fluid is most appropriate to initiate for a patient newly diagnosed with DKA and signs of hypovolemic shock? A. Dextrose 5% in 0.9% NaCl B. Dextrose 10% in water C. 0.9% NaCl D. Lactated Ringer’s with insulin

C. 0.9% NaCl Rationale: Isotonic saline (0.9% NaCl) is the fluid of choice to restore blood pressure and circulating volume in hypovolemic states such as DKA.

Which of the following are indications that a patient with DKA should be hospitalized rather than managed at home? (SATA) A. Ability to monitor glucose at home B. Persistent vomiting C. Fever and signs of infection D. Alert and oriented with stable vitals E. Altered mental status

B. Persistent vomiting C. Fever and signs of infection E. Altered mental status Rationale: Hospitalization is needed if the patient has infection, vomiting, mental status changes, or other complications that cannot be safely managed at home.

A nurse is caring for a patient receiving insulin for DKA. The patient’s potassium level drops from 4.5 to 3.1 mEq/L. What is the priority nursing action? A. Continue insulin and monitor labs B. Stop insulin and give oral potassium C. Notify the provider and administer IV potassium D. Recheck glucose before making any changes

C. Notify the provider and administer IV potassium Rationale: Potassium levels can fall rapidly during insulin therapy. IV potassium should be administered to prevent cardiac complications of hypokalemia.

When glucose levels approach 250 mg/dL during DKA management, which intervention is most appropriate? A. Add dextrose to the IV fluids B. Increase insulin infusion rate C. Discontinue IV fluids D. Restrict fluid intake to avoid hyponatremia

A. Add dextrose to the IV fluids Rationale: Adding 5–10% dextrose helps prevent hypoglycemia and avoids a rapid glucose drop that could cause cerebral edema.

A patient with heart failure is admitted with DKA. Which action is most important when initiating IV fluid therapy? A. Administer fluids at a rapid rate B. Use D5W to avoid sodium overload C. Administer potassium regardless of serum levels D. Monitor for signs of fluid overload

D. Monitor for signs of fluid overload Rationale: Patients with heart or kidney disease are at risk for fluid overload. Monitoring for signs like crackles or edema is crucial.

Why is it essential to monitor serum potassium closely during DKA treatment with insulin? A. Potassium levels remain unaffected during treatment B. Potassium is excreted rapidly by the kidneys C. Insulin increases potassium excretion through sweat D. Insulin shifts potassium into cells, lowering serum levels

D. Insulin shifts potassium into cells, lowering serum levels Rationale: Insulin drives potassium into cells, which lowers serum potassium and can cause life-threatening hypokalemia if not corrected.

A patient in DKA is being treated with IV fluids and insulin. After two hours, their glucose drops rapidly from 480 mg/dL to 210 mg/dL. Which complication is the nurse most concerned about? A. Myocardial infarction B. Cerebral edema C. Acute pancreatitis D. Hepatic failure

B. Cerebral edema Rationale: A rapid decrease in glucose levels can shift fluid into brain cells, increasing the risk for cerebral edema, especially in younger patients.

Which of the following best describes the purpose of adding dextrose to the IV fluids during DKA management? A. Prevents hyponatremia B. Enhances ketone production C. Prevents rebound hyperglycemia D. Avoids hypoglycemia and cerebral edema

D. Avoids hypoglycemia and cerebral edema Rationale: As glucose normalizes, dextrose is added to prevent sudden hypoglycemia and reduce the risk of cerebral edema due to osmotic shifts.

A patient in DKA is started on insulin therapy. Their urine output improves, and BP stabilizes. Labs show glucose 245 mg/dL and potassium 3.2 mEq/L. What is the next best action? A. Switch to subcutaneous insulin B. Add dextrose to the IV fluids C. Hold insulin until potassium increases D. Give IV potassium and continue insulin

D. Give IV potassium and continue insulin Rationale: Insulin therapy should not be held once started, but potassium must be supplemented to prevent hypokalemia. Dextrose may also be added based on glucose trends.

What is the ideal target rate of glucose reduction per hour during insulin therapy in DKA? A. 10–20 mg/dL B. 36–54 mg/dL C. 70–100 mg/dL D. 100–150 mg/dL

B. 36–54 mg/dL Rationale: A controlled glucose reduction of 36–54 mg/dL per hour (2 to 3 mmol/L/hr helps prevent complications such as cerebral edema and vascular instability.

A nurse is preparing to initiate insulin therapy in a patient with DKA. Which of the following lab results would require the nurse to delay starting insulin? A. Glucose 520 mg/dL B. pH 7.27 C. Potassium 2.8 mEq/L D. Urine positive for ketones

C. Potassium 2.8 mEq/L Rationale: Insulin therapy should be held if potassium is below 3.3 mEq/L to avoid worsening hypokalemia, which can cause cardiac arrhythmias.

Which electrolytes are typically monitored and replaced during the treatment of DKA? (SATA) A. Calcium B. Potassium C. Magnesium D. Bicarbonate E. Phosphate

B. Potassium C. Magnesium D. Bicarbonate E. Phosphate Rationale: DKA leads to losses in potassium, magnesium, phosphate, and bicarbonate. Calcium is typically not involved unless another issue is present.

Why is insulin therapy essential in the management of DKA? A. Promotes hepatic gluconeogenesis B. Stimulates ketone formation for energy C. Drives glucose into cells and stops ketone production D. Enhances sodium retention

C. Drives glucose into cells and stops ketone production Rationale: Insulin lowers blood glucose by facilitating its uptake into cells and suppresses fat breakdown, which reduces ketone production and corrects acidosis.

Which of the following assessment findings is most indicative of severe dehydration in a patient with DKA? A. Increased thirst B. Sunken eyes and dry mucous membranes C. Kussmaul respirations D. Fruity-smelling breath

B. Sunken eyes and dry mucous membranes Rationale: Dry mucous membranes and sunken eyes indicate significant fluid loss, consistent with dehydration in DKA. Kussmaul respirations and fruity breath are signs of acidosis, not specifically dehydration.

A 22-year-old with type 1 DM presents with nausea, vomiting, dry skin, and a fruity breath odor. Blood glucose is 510 mg/dL. What is the nurse’s priority intervention? A. Begin fluid resuscitation with 0.9% NaCl at 1 L/hr B. Administer subcutaneous insulin C. Obtain a urine sample for ketones D. Place the patient in a high Fowler’s position

A. Begin fluid resuscitation with 0.9% NaCl at 1 L/hr Rationale: The priority in DKA management is fluid resuscitation to restore intravascular volume, improve perfusion, and support renal function.

What is the first step in the emergency management of a patient with suspected DKA? A. Start insulin infusion B. Insert a Foley catheter C. Ensure a patent airway D. Administer potassium chloride

C. Ensure a patent airway Rationale: Airway management is always the first priority in emergency care. DKA patients may have altered mental status or labored breathing requiring immediate airway support.

Which of the following are expected assessment findings in DKA? (SATA) A. Bradycardia B. Dry mouth C. Kussmaul respirations D. Serum glucose >250 mg/dL E. Decreased urinary frequency

B. Dry mouth C. Kussmaul respirations D. Serum glucose >250 mg/dL Rationale: DKA presents with dehydration symptoms like dry mouth, labored (Kussmaul) respirations from acidosis, and elevated glucose. Urinary frequency typically increases in early DKA due to osmotic diuresis.

Why is potassium replacement monitored closely in a patient with DKA receiving insulin therapy? A. Insulin increases potassium excretion through the kidneys B. Insulin causes potassium to shift into the cells C. Insulin increases potassium absorption in the GI tract D. Insulin has no effect on potassium levels

B. Insulin causes potassium to shift into the cells Rationale: Insulin drives potassium into cells, lowering serum potassium, which can lead to dangerous hypokalemia if not corrected.

A nurse is caring for a patient with DKA who is receiving a continuous insulin infusion. The patient’s pH is 6.95. Which intervention is indicated? A. Increase the insulin rate B. Withhold insulin until pH improves C. Administer sodium bicarbonate IV D. Give dextrose to buffer acid

C. Administer sodium bicarbonate IV Rationale: Sodium bicarbonate is only given in cases of severe acidosis (pH <7.0) to help correct the dangerously low pH level.

A patient is admitted with DKA. Initial labs show: K+ 3.2 mEq/L, glucose 600 mg/dL, pH 7.18. Which of the following orders should the nurse prioritize? A. Start insulin infusion B. Begin bicarbonate infusion C. Replace potassium before starting insulin D. Administer 5% dextrose in 0.45% NaCl

C. Replace potassium before starting insulin Rationale: Potassium should be corrected before insulin starts because insulin shifts potassium into the cells, further lowering levels and increasing arrhythmia risk.

What is the purpose of giving oxygen via nasal cannula or nonrebreather mask during DKA treatment? A. To treat ketone buildup B. To enhance glucose uptake C. To correct hypoxia and improve tissue perfusion D. To dry out mucous membranes

C. To correct hypoxia and improve tissue perfusion Rationale: Hypoxia may occur due to dehydration, acidosis, and poor perfusion. Oxygen administration supports tissue oxygenation and reduces the work of breathing.

Which finding would most warrant immediate action in a patient receiving DKA treatment? A. Serum potassium of 2.9 mEq/L B. Serum glucose of 290 mg/dL C. Blood pressure of 110/70 mmHg D. Urine output of 40 mL/hr

A. Serum potassium of 2.9 mEq/L Rationale: A potassium level below 3.0 mEq/L is dangerous during insulin therapy and must be corrected to avoid life-threatening arrhythmias.

Which of the following best describes the significance of monitoring ECG changes during DKA management? A. To detect fluid overload B. To identify glucose toxicity C. To monitor for potassium imbalances D. To detect insulin resistance

C. To monitor for potassium imbalances Rationale: ECG monitoring is critical for identifying arrhythmias associated with hyper- or hypokalemia during DKA treatment.

A nurse is monitoring a patient with DKA on an insulin drip. The patient’s glucose is now 245 mg/dL. Which is the next best step? A. Stop insulin drip B. Add dextrose to IV fluids C. Decrease fluid rate D. Give potassium regardless of level

B. Add dextrose to IV fluids Rationale: When glucose levels fall to <250 mg/dL, dextrose is added to prevent hypoglycemia and reduce the risk of cerebral edema.

A nurse is assessing a patient with suspected DKA. Which of the following would most strongly support the diagnosis? A. Recent weight loss and polyphagia B. Serum glucose 200 mg/dL C. Deep, labored respirations with fruity odor D. Blood pressure 140/90 mmHg

C. Deep, labored respirations with fruity odor Rationale: Kussmaul respirations with fruity breath are classic signs of ketoacidosis, confirming DKA.

What is the most important reason to establish large-bore IV access in a patient with DKA? A. For quick blood sampling B. To reduce pain during medication administration C. To manage electrolyte levels D. To rapidly administer fluids and medications

D. To rapidly administer fluids and medications Rationale: Large-bore IV access allows for high-volume fluid resuscitation and IV insulin in critically ill patients.

Which of the following are essential components of ongoing monitoring in a patient with DKA? (SATA) A. Monitor O2 saturation B. Measure serum sodium every 6 days C. Track urine output D. Monitor level of consciousness E. Check serum potassium levels frequently

A. Monitor O2 saturation C. Track urine output D. Monitor level of consciousness E. Check serum potassium levels frequently Rationale: Continuous monitoring of vital signs, mental status, electrolytes, and fluid balance is essential. Sodium should be monitored daily or more often—not every 6 days.

A nurse is monitoring breath sounds in a patient receiving aggressive fluid therapy for DKA. Crackles are heard in the lungs. What is the priority action? A. Increase the fluid rate B. Administer diuretics C. Notify the provider of possible fluid overload D. Recheck blood glucose levels

C. Notify the provider of possible fluid overload Rationale: Crackles indicate fluid accumulation in the lungs, suggesting overload. The provider must be notified to adjust fluids or initiate treatment.

A DKA patient is showing signs of confusion and lethargy. Which finding would most likely explain the mental status change? A. Glucose level of 260 mg/dL B. Potassium 4.2 mEq/L C. pH of 6.98 D. Urine output of 60 mL/hr

C. pH of 6.98 Rationale: Severe acidosis (pH <7.0) can impair cerebral function, leading to confusion and lethargy. This is a red flag that requires urgent intervention.

In managing DKA, when is it most appropriate to administer sodium bicarbonate? A. Serum pH <7.0 B. Serum glucose >600 mg/dL C. Kussmaul respirations are present D. Patient is vomiting

A. Serum pH <7.0 Rationale: Sodium bicarbonate is reserved for severe metabolic acidosis with pH <7.0. Otherwise, it’s typically avoided due to complications.

A nurse is assessing a patient with DKA. The patient has abdominal pain, ketonuria, and Kussmaul respirations. Glucose is 580 mg/dL and pH is 7.22. What is the most urgent nursing diagnosis? A. Risk for injury B. Fluid volume deficit C. Acute pain D. Imbalanced nutrition: less than body requirements

B. Fluid volume deficit Rationale: Fluid volume deficit is the priority diagnosis due to dehydration, osmotic diuresis, and fluid shifts. Immediate fluid replacement is necessary to prevent shock.

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium.

c. rapid, deep respirations.

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider would the nurse implement first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Ask the patient about home insulin doses. d. Start an insulin infusion at 0.1 units/kg/hr.

a. Place the patient on a cardiac monitor. Rationale: Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse would initiate cardiac monitoring before infusion of potassium. Insulin would not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Discussion of home insulin and possible causes can wait until the patient is stabilized.

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action would the nurse implement first? a. Infuse 1 L of normal saline rapidly. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr.

a. Infuse 1 L of normal saline rapidly. Rationale: The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. Insulin can be given after the infusion of normal saline is initiated. Sodium bicarbonate may be given for severe acidosis (pH <7.0) after fluids are initiated.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action would the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.

c. Obtain a glucose reading using a finger stick. Rationale: The patient‘s clinical manifestations are consistent with hypoglycemia, and the initial action should be to check the patient‘s glucose with a finger stick or order a stat glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patient‘s symptoms become worse or if the patient is unconscious.