A nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention?

Choice A reason: A blood pH of 7.45 is normal or slightly alkalotic, not indicative of DKA, which causes metabolic acidosis due to ketone accumulation. DKA typically presents with a pH below 7.35, reflecting acid-base imbalance from ketoacid production, making this finding inconsistent with DKA.

Choice B reason: A serum bicarbonate of 12 mEq/L indicates metabolic acidosis, a hallmark of DKA. Ketoacids produced from fat metabolism in uncontrolled hyperglycemia consume bicarbonate, lowering its levels, confirming DKA’s acid-base disturbance and making this the most indicative laboratory finding.

Choice C reason: A blood glucose of 200 mg/dL is elevated but not specific to DKA, which typically involves glucose levels above 250 mg/dL, often much higher. This level could indicate hyperglycemia but does not confirm the severe metabolic acidosis characteristic of DKA.

Choice D reason: Serum potassium of 5.5 mEq/L suggests hyperkalemia, common in DKA due to acidosis shifting potassium extracellularly. However, it is less specific than low bicarbonate, as hyperkalemia can occur in other conditions, and bicarbonate directly reflects DKA’s acidotic state.

Choice A reason: A blood glucose of 750 mg/dL indicates severe hyperglycemia, potentially diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), both life-threatening. Notifying the RN and provider ensures rapid intervention, such as IV insulin and fluids, to correct glucose, acidosis, and dehydration, preventing multi-organ failure or coma.

Choice B reason: Verifying diabetes type is important but not the priority with a glucose of 750 mg/dL. Both type 1 (DKA risk) and type 2 (HHS risk) require urgent treatment for severe hyperglycemia. Delaying action for record review risks worsening metabolic decompensation, making this less urgent.

Choice C reason: Administering sliding scale insulin without provider guidance is unsafe for severe hyperglycemia (750 mg/dL), as it may be insufficient for DKA or HHS. IV insulin and fluid therapy are typically required, and acting independently risks inadequate treatment, delaying critical care and worsening patient outcomes.

Choice D reason: Assessing vital signs is useful but not the priority. Severe hyperglycemia requires immediate medical intervention to correct metabolic derangements. Vital signs may indicate shock or dehydration, but notifying the provider ensures comprehensive management, including diagnostics and treatment, addressing the root cause more effectively.