NCLEX-RNPhysiological AdaptationMedium
A client with type 1 diabetes is admitted with fruity breath, Kussmaul respirations, and blood glucose of 480 mg/dL. Arterial blood gas shows pH 7.22, HCO3- 10 mEq/L, PaCO2 28 mmHg. Which action is the nurse's priority?
- ARestrict oral fluids to prevent cerebral edema
- BBegin an IV insulin infusion after fluid resuscitation
- CAdminister sodium bicarbonate IV push
- DAdminister 50% dextrose IV
Show answer & explanationAnswer & explanation
Correct answer: B. Begin an IV insulin infusion after fluid resuscitation
This client is in diabetic ketoacidosis (DKA); after initial isotonic fluid resuscitation to correct hypovolemia, IV regular insulin infusion is the priority to reverse ketosis and correct the metabolic acidosis. Bicarbonate is not routinely given and dextrose would worsen hyperglycemia.
Why the other options are wrong
- A. Fluids are needed, not restricted, in DKA to correct severe dehydration.
- C. Bicarbonate is reserved for severe acidosis (pH <6.9) and not first-line treatment.
- D. Dextrose would worsen the already elevated blood glucose.
DKA Management Priorities
Diabetic ketoacidosis treatment sequence is fluids, then insulin, then potassium replacement as needed.
- Isotonic saline corrects volume deficit first
- Insulin infusion stops ketogenesis and lowers glucose
- Monitor potassium closely as insulin drives K+ into cells
- Bicarbonate reserved for severe acidosis only
Memory trick: Fluids First, then Fix with Insulin