# A client with diabetic ketoacidosis has a serum potassium of 3.1 mEq/L before the insulin infusion is started. Which action should the nurse anticipate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397453&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with diabetic ketoacidosis has a serum potassium of 3.1 mEq/L before the insulin infusion is started. Which action should the nurse anticipate?

## Option

1. Start the insulin infusion immediately without additional orders.
2. Replace potassium as prescribed before or with insulin therapy. **✔ Correct answer**
3. Give sodium polystyrene sulfonate to lower the potassium.
4. Restrict all IV fluids until the potassium is normal.

**Correct answer: 2**

## Explanation

Insulin shifts potassium into cells and can worsen hypokalemia. In diabetic ketoacidosis, low potassium must be corrected according to protocol before or with insulin therapy to reduce dysrhythmia risk. Potassium-lowering therapy or fluid restriction would be unsafe in this cue pattern.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits DKA with low potassium.

Memory Tip
Match the strongest cue cluster to the safest nursing judgment.

KR vs US
NCLEX items reward cue-based priority thinking rather than isolated recall.

## Clinical scenario

Clinical Practice Guide
For DKA with low potassium, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **Diabetic Ketoacidosis** — A hyperglycemic emergency with ketosis, dehydration, and metabolic acidosis.
- **Hypokalemia** — Low serum potassium that can cause muscle weakness and dysrhythmias.
- **Insulin Infusion** — Continuous IV insulin used to treat severe hyperglycemia and ketoacidosis.

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