While caring for a patient with diabetic ketoacidosis (DKA), which of the following lab values would you want to communicate with the HCP before starting an insulin drip?
Calcium:8.5
Phosphorous: 4.0
Potassium: 2.8
Glucose: 275
The Correct Answer is C
A. Calcium: 8.5 is incorrect because this value is within the normal reference range (approximately 8.5–10.5 mg/dL). Calcium levels, unless critically abnormal, do not affect the decision to start insulin in DKA.
B. Phosphorus: 4.0 is incorrect because this is also within the normal reference range (2.5–4.5 mg/dL). Although phosphorus levels can drop during DKA treatment due to insulin shifting phosphorus into cells, an initial normal phosphorus level does not preclude starting insulin.
C. Potassium: 2.8 is correct because hypokalemia is a major safety concern when initiating insulin therapy. Insulin promotes the movement of potassium from the extracellular space into cells, which can further lower already low potassium levels. Severe hypokalemia can lead to life-threatening cardiac arrhythmias, including ventricular tachycardia or fibrillation. For this reason, current guidelines recommend holding insulin until potassium is corrected to ≥3.3 mEq/L and administering potassium replacement as ordered. The nurse must communicate this lab result to the healthcare provider before starting the insulin drip to prevent serious complications.
D. Glucose: 275 is incorrect because hyperglycemia is expected in DKA. While high glucose confirms the need for insulin therapy, it is not a contraindication to starting treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Skull fracture is correct because bruising behind the ears (Battle’s sign) and around the eyes (raccoon eyes) are classic indicators of a basal skull fracture. These bruises result from bleeding from the fracture site tracking into surrounding soft tissues. Basal skull fractures carry significant risks, including cerebrospinal fluid (CSF) leak, intracranial hemorrhage, and cranial nerve injury, and require urgent assessment and monitoring.
B. Mastoiditis is incorrect because this is an infection of the mastoid bone, usually secondary to untreated middle ear infections. While bruising is near the mastoid area, mastoiditis does not cause Battle’s signafter trauma.
C. Subdural hematoma is incorrect because although head trauma can cause subdural hematomas, the presence of periorbital and postauricular bruising specifically indicates a skull fracture, not a hematoma itself. Subdural hematomas require imaging for diagnosis and may accompany a skull fracture but are not diagnosed by bruising patterns alone.
D. Concussion is incorrect because a concussion is a functional brain injury without structural damage. While it can occur with head trauma, raccoon eyes and Battle’s sign are not typical of concussion; they indicate structural skull damage.
Correct Answer is A
Explanation
A. Decrease in secretion of hydrogen ions is correct because in acute kidney injury (AKI), the kidneys lose their ability to excrete hydrogen ions effectively. This leads to accumulation of acids in the blood, resulting in metabolic acidosis. Additionally, impaired kidney function reduces bicarbonate reabsorption, further worsening acidosis.
B. Increase in production of bicarbonate from the kidneys is incorrect because bicarbonate production is reduced in AKI, not increased. Adequate bicarbonate is necessary to buffer acids, and its reduction contributes to metabolic acidosis.
C. Rapid breathing is incorrect because rapid breathing (Kussmaul respirations)is a compensatory response to metabolic acidosis, not a cause. It occurs as the body attempts to blow off CO₂to reduce acid levels.
D. Increased blood pressure is incorrect because while hypertension may be associated with kidney injury, it does not directly contribute to metabolic acidosis. The acid-base imbalance is primarily due to renal failure to excrete hydrogen ions and conserve bicarbonate.
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