# Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. Place the medication and monitoring steps in the safest sequence. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=522753&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## Question Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. Place the medication and monitoring steps in the safest sequence. Add prescribed dextrose as glucose declines so insulin can continue until ketonemia and acidosis resolve. Treat the infectious precipitant and continue serial beta-hydroxybutyrate, pH, bicarbonate, electrolytes, renal, and clinical reassessment. Hold empagliflozin, assess airway and circulation, establish monitoring, and obtain the immediate glucose, ketone, electrolyte, renal, and venous pH studies. Begin authorized isotonic fluids and reassess perfusion, urine output, lung findings, and kidney function. Verify potassium and start protocol-directed insulin when safe, with frequent glucose and potassium checks. ## Explanation The sequence ends the suspect exposure, assesses severity, restores perfusion, protects potassium during insulin therapy, adds dextrose before hypoglycemia interrupts ketone clearance, and closes the loop with precipitant treatment and serial outcomes. ## In-depth explanation Quick answer Sequence hold and assess, hydrate, verify potassium and insulin, add dextrose, then trend to resolution. Why this is correct Severe potassium depletion, kidney dysfunction, or volume overload risk changes the authorized protocol. Insulin should not be stopped merely because glucose falls while ketoacidosis persists. Easy analogy or mental picture Build a medication safety chain: identify the cue cluster, connect it to the drug mechanism, stop preventable exposure, stabilize the client, and verify the response with measurable findings. Memory hook Cue cluster, medication mechanism, protective action, and measurable reassessment. NCLEX decision rule Choose the action that prevents the most immediate medication-related harm while preserving treatment for the underlying condition. Why the other choices are wrong Options that rely on one reassuring value, continue a suspect exposure, bypass monitoring, or delay escalation leave the medication hazard active.References 1FDA Drug Safety Communication: SGLT2 inhibitor ketoacidosisKetoacidosis can occur with lower-than-expected glucose during infection, reduced intake, surgery, dehydration, or insulin reduction 22024 Consensus Report: Hyperglycemic Crises in Adults With DiabetesEuglycemic DKA recognition, fluids, insulin, dextrose, potassium, precipitant treatment, and resolution criteria 3Surviving Sepsis Campaign International Guidelines 2021Prompt infection evaluation, cultures when appropriate, antimicrobials, fluids, perfusion, and serial reassessment ## Clinical scenario Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. ## Related questions - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en) - [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en) - [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=en) - [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=en) - [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522753&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522753&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522753&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522753&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522753&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._