# A client with diabetic ketoacidosis is prescribed IV insulin. The potassium level is 2.9 mEq/L. Which action should the nurse anticipate before starting the insulin infusion?

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> language: en  
> subject: Illness Management  
> category: PA

## Question

A client with diabetic ketoacidosis is prescribed IV insulin. The potassium level is 2.9 mEq/L. Which action should the nurse anticipate before starting the insulin infusion?

## Option

1. Start insulin immediately because potassium will rise.
2. Replace potassium as prescribed and place the client on cardiac monitoring. **✔ Correct answer**
3. Give oral glucose and discharge the client.
4. Restrict all IV fluids until potassium is normal.

**Correct answer: 2**

## Explanation

Insulin shifts potassium into cells and can worsen hypokalemia, increasing dysrhythmia risk. A potassium level of 2.9 mEq/L requires replacement and monitoring before or with insulin according to protocol. DKA also requires fluids and close monitoring, not discharge.

## In-depth explanation

Clinical Judgment
In DKA, insulin treats acidosis but can make low potassium dangerous.

Memory Tip
Check potassium before insulin.

## Clinical scenario

Clinical Practice Guide
DKA management includes fluids, insulin, potassium monitoring and replacement, glucose trends, and acid-base correction.

Caution
Hypokalemia can become life-threatening when insulin is started.

## Key concepts

- **Diabetic Ketoacidosis** — A serious diabetic emergency involving hyperglycemia, ketosis, and acidosis.
- **Hypokalemia** — A low serum potassium level that can cause muscle weakness and dysrhythmias.
- **Insulin Infusion** — Continuous IV insulin therapy used in selected hyperglycemic emergencies.

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