# Stage 2 — Analyze cues. For each finding, identify the conclusion it most directly supports.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568679&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

Stage 2 — Analyze cues. For each finding, identify the conclusion it most directly supports.

|  | Supports DKA diagnosis | Supports volume depletion | Signals potassium risk during treatment | Does not define the acute crisis by itself |
| --- | --- | --- | --- | --- |
| Beta-hydroxybutyrate 5.8 mmol/L, pH 7.19, and bicarbonate 10 mmol/L |  |  |  |  |
| BP 96/60 mm Hg with dry mucosa and delayed capillary refill |  |  |  |  |
| Potassium 5.4 mmol/L before fluids and insulin |  |  |  |  |
| Hemoglobin A1C 9.8% |  |  |  |  |

## Explanation

Ketonemia with acidosis establishes DKA, hypotension and delayed refill reflect volume depletion, and a normal-high potassium can fall rapidly after insulin despite total-body potassium loss. A high A1C reflects chronic control but does not alone define the immediate crisis.

## In-depth explanation

Quick answer
Separate diagnostic ketosis and acidosis from volume-loss cues and from the potassium drop expected during treatment.

Why this is correct
Serum potassium may begin normal or high even though total-body potassium is depleted. Insulin, volume expansion, and correction of acidosis move potassium down, so the initial value cannot be treated as a surplus.

Easy analogy or mental picture
The blood potassium is a snapshot of what is outside the cells, not the total warehouse inventory. Insulin moves stock back inside and can reveal the shortage quickly.

Memory hook
High serum potassium can hide a depleted DKA body.

NCLEX decision rule
Before and during DKA insulin therapy, trend potassium rather than trusting the arrival value; connect each cue to diagnosis, perfusion, or treatment risk.

Why the other choices are wrong
Chronic glycemic control does not determine the immediate resuscitation sequence, and the diagnostic ketone-acid pattern should not be mislabeled as a potassium or volume finding.

References
1Hyperglycemic Crises in Adults With Diabetes: A Consensus ReportDKA diagnosis, fluids, insulin, potassium, dextrose, monitoring, resolution, and transition

## Clinical scenario

Case update
The nurse groups the initial findings before initiating the potassium-guided insulin protocol.

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