# Place the actions in order for an adult with diabetic ketoacidosis and an initial potassium level of 3.0 mmol/L. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question Place the actions in order for an adult with diabetic ketoacidosis and an initial potassium level of 3.0 mmol/L. Monitor glucose every 1 to 2 hours and potassium, ketones, pH, fluid balance, and treatment complications at protocol intervals Assess airway, breathing, circulation, mental status, volume status, glucose, ketones, acid-base findings, kidney function, and electrolytes When potassium rises above 3.5 mmol/L, begin prescribed IV regular insulin and adjust fluids and dextrose according to glucose and ketone response Begin prescribed isotonic or balanced crystalloid resuscitation and evaluate hemodynamic and pulmonary response Begin prescribed potassium replacement and cardiac monitoring while continuing fluid resuscitation ## Explanation Confirm DKA severity, hypovolemia, and electrolyte risk first. Begin crystalloid resuscitation, then replace potassium because the initial level is below 3.5 mmol/L. Delay insulin until potassium is above 3.5 mmol/L to reduce the risk of life-threatening arrhythmia and respiratory muscle weakness. Once safe, start insulin and continue frequent glucose, potassium, ketone, acid-base, and fluid-balance monitoring. ## In-depth explanation Correct sequence Assess → crystalloid → potassium replacement → insulin only after potassium exceeds 3.5 mmol/L → frequent multidomain monitoring. Why this is correct Total-body potassium is depleted in DKA. Insulin shifts potassium into cells and can turn an already low serum level into a fatal arrhythmia or muscle weakness. NCLEX decision rule In DKA with potassium below 3.5 mmol/L, fluids and potassium come before insulin.References 12024 Hyperglycemic Crises Consensus Report 2Diabetologia consensus publication ## Clinical scenario DKA with hypokalemia The client has glucose 468 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, pH 7.19, dehydration, and a patent IV. Prescriptions follow the 2024 international hyperglycemic-crisis consensus report. ## Key concepts - **Beta-Hydroxybutyrate** — The predominant circulating ketone measured to diagnose and follow diabetic ketoacidosis. - **Total-Body Potassium Deficit** — Loss of potassium from the body even when the initial serum concentration appears normal or high. - **Euglycemic DKA** — Diabetic ketoacidosis with significant ketosis and acidosis despite glucose below the traditional hyperglycemic range. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&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._