Which laboratory finding is most indicative of diabetic ketoacidosis (DKA)?

Increased serum bicarbonate level

Decreased blood pH

Elevated blood glucose level

Elevated blood urea nitrogen (BUN) level

Answer and Explanation

The Correct Answer is B

Rationale:

A. Increased serum bicarbonate level: In diabetic ketoacidosis, bicarbonate levels are decreased because bicarbonate is consumed as it buffers the excess ketone acids. An increased bicarbonate level would not be consistent with DKA.

B. Decreased blood pH: The accumulation of ketone bodies in DKA leads to metabolic acidosis. A decreased blood pH, typically below 7.35, is one of the most definitive laboratory findings indicating diabetic ketoacidosis.

C. Elevated blood glucose level: Hyperglycemia is present in DKA, often exceeding 250 mg/dL. However, elevated glucose alone is not specific to DKA since it also occurs in hyperosmolar hyperglycemic state (HHS). The distinguishing factor in DKA is acidosis.

D. Elevated blood urea nitrogen (BUN) level: Increased BUN may occur in DKA due to dehydration and reduced renal perfusion. While it supports the diagnosis, it is not the most specific indicator of DKA compared with blood pH changes.

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Correct Answer is ["B","C","E"]

Explanation

Rationale:

A. Black cohosh: This supplement is primarily used for menopausal symptoms and has estrogen-like effects. It is not strongly associated with increased bleeding risk when combined with anticoagulants, so it is not a priority to stop before starting warfarin.

B. Gingko biloba: Gingko interferes with platelet aggregation, increasing the risk of bleeding when taken with warfarin. Combining these two agents can potentiate anticoagulant effects and raise the likelihood of serious hemorrhagic complications.

C. Flaxseed oil: Flaxseed oil contains omega-3 fatty acids that can reduce platelet aggregation. When combined with warfarin, this increases the client’s risk for bleeding and should be discontinued prior to initiating therapy.

D. Glucosamine: Glucosamine is typically used for osteoarthritis and joint health. It does not significantly impact coagulation pathways or platelet function, so it does not pose a major interaction risk with warfarin.

E. Saw palmetto: Saw palmetto has antiplatelet effects that can increase the likelihood of bleeding in clients receiving anticoagulation. For safety, it should be discontinued before starting warfarin.

A. regular insulin and normal saline B. 5% Dextrose C. Regular insulin and 5% dextrose D. Normal Saline

Correct Answer is A

Explanation

Rationale:

A. regular insulin and normal saline: In diabetic ketoacidosis, the priority is fluid resuscitation with isotonic saline to correct dehydration and restore perfusion. Regular insulin is then started to reduce blood glucose and stop ketone production.

B. 5% Dextrose: Dextrose is not given initially because the patient’s blood glucose is still elevated in DKA. It is introduced later in therapy once glucose levels fall to around 250 mg/dL, to prevent hypoglycemia while continuing insulin therapy.

C. Regular insulin and 5% dextrose: Insulin is needed, but dextrose would not be appropriate at this stage because glucose is already significantly elevated. Giving dextrose too early would worsen hyperglycemia and delay correction of ketoacidosis.

D. Normal Saline: Normal saline alone helps correct dehydration but does not address the underlying problem of insulin deficiency. Without insulin therapy, ketosis and acidosis would persist despite fluid replacement.

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Which laboratory finding is most indicative of diabetic ketoacidosis (DKA)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a male client who has peripheral vascular disease (PVD), is taking dietary supplements, and has a new prescription for warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting the warfarin? (Select all that apply.)

Correct Answer is ["B","C","E"]

Explanation

A patient with diabetic ketoacidosis has the following laboratory test results; glucose 120; pH7.31; PCO2 33; serum potassium 5.3; urine ketones positive +3. Which should the nurse anticipate starting?

Correct Answer is A

Explanation

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