# An 11-year-old is admitted with new-onset diabetic ketoacidosis (DKA): blood glucose 612 mg/dL, pH 7.18, bicarbonate 8, ketones large. Which nursing actions reflect safe pediatric DKA management? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374873&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

An 11-year-old is admitted with new-onset diabetic ketoacidosis (DKA): blood glucose 612 mg/dL, pH 7.18, bicarbonate 8, ketones large. Which nursing actions reflect safe pediatric DKA management? Select all that apply.

1

Monitor closely for signs of cerebral edema (severe headache, sudden mental status change, bradycardia with hypertension, posturing) which is the leading cause of DKA mortality in children.

2

Administer a sodium bicarbonate infusion to raise the serum pH to at least 7.35 to prevent myocardial depression and improve insulin sensitivity during DKA management.

3

Add potassium to the IV fluids once urine output is established and potassium is in the normal-to-low range; insulin shifts potassium intracellularly.

4

Begin gradual isotonic fluid resuscitation (10 to 20 mL/kg over 30 to 60 minutes initially), then continue at maintenance plus deficit replacement over 36 to 48 hours — NOT aggressive boluses.

5

Start a continuous regular insulin drip at 0.05 to 0.1 unit/kg/hour AFTER the initial fluid bolus (not before) and only when potassium is verified ≥ 3.5 mEq/L.

## Explanation

Pediatric DKA management priorities: GRADUAL isotonic fluid replacement (rapid boluses can precipitate cerebral edema), insulin drip 0.05-0.1 unit/kg/hr AFTER initial fluid and only when K+ ≥ 3.5, vigilant cerebral edema monitoring (the leading cause of pediatric DKA death), and potassium repletion as glucose drops with insulin. Choice 2 is wrong — bicarbonate is NOT routinely given in pediatric DKA except in extreme acidosis (pH < 6.9) due to association with worsened cerebral edema.

## In-depth explanation

Pediatric DKA differs from adult DKA: cerebral edema is a leading killer (5-10% in children, rare in adults), so fluids are GRADUAL not aggressive, bicarbonate is generally avoided, and any new headache or LOC change during treatment is a STAT call. Insulin always AFTER fluids and after K+ check.

## Clinical scenario

**11-year-old, new-onset DKA**: glucose **612 mg/dL**, pH **7.18**, bicarbonate **8**, ketones large. Vital signs: HR 132, RR 28 with Kussmaul respirations, BP 96/58, mild dehydration. Pediatric ICU admission planned.

## Key concepts

- **Pediatric DKA** — Hyperglycemia + ketosis + acidosis in children; cerebral edema is the leading cause of mortality.
- **Cerebral edema warning signs** — Severe headache, decreased LOC, Cushing triad (bradycardia, hypertension, irregular respirations), posturing, incontinence — STAT call.
- **Insulin in DKA timing** — Start AFTER initial fluid bolus and only when K+ ≥ 3.5 mEq/L; insulin without K+ verification can precipitate fatal hypokalemia.

## Related questions

- [A 58-year-old patient with metastatic lung cancer is admitted with progressive dyspnea, hy…](https://mymerci.kr/pages/nclex_q.php?qn_id=372843&lang=en)
- [A trauma patient who sustained blunt chest injury becomes acutely diaphoretic and hypotens…](https://mymerci.kr/pages/nclex_q.php?qn_id=372844&lang=en)
- [A patient with stage 5 chronic kidney disease has missed two scheduled hemodialysis sessio…](https://mymerci.kr/pages/nclex_q.php?qn_id=372845&lang=en)
- [An adult patient has been seizing continuously for 6 minutes. The provider asks the nurse …](https://mymerci.kr/pages/nclex_q.php?qn_id=373126&lang=en)
- [Four patients arrive in the ED. Which patient presentation indicates a hypertensive EMERGE…](https://mymerci.kr/pages/nclex_q.php?qn_id=373127&lang=en)
- [A 55-year-old patient on post-op day 5 from an extensive abdominal surgery suddenly develo…](https://mymerci.kr/pages/nclex_q.php?qn_id=373402&lang=en)
- [Four adults with asthma arrive at the urgent care. Which presentation indicates the MOST s…](https://mymerci.kr/pages/nclex_q.php?qn_id=373879&lang=en)
- [A client with myasthenia gravis on scheduled pyridostigmine reports increasing weakness, a…](https://mymerci.kr/pages/nclex_q.php?qn_id=374963&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=374873&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=374873&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=374873&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=374873&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=374873&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._