# Stage 5 — Take action. Potassium is now 3.8 mmol/L. Place the high-alert insulin actions in the safest sequence.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568682&lang=en  
> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

Stage 5 — Take action. Potassium is now 3.8 mmol/L. Place the high-alert insulin actions in the safest sequence.

Independently verify the insulin concentration, client, pump settings, and line with another nurse

Perform scheduled glucose, potassium, beta-hydroxybutyrate, and acid-base reassessments

Start the verified insulin infusion through the designated line

Confirm the current potassium meets the protocol threshold and review the active prescription

Add prescribed dextrose and adjust the insulin rate when glucose falls below 250 mg/dL while ketosis is still resolving

## Explanation

Confirm that potassium permits insulin, complete an independent high-alert verification, start the infusion through the designated line, perform scheduled monitoring, and add dextrose with rate adjustment when glucose falls while insulin continues to clear ketones.

## In-depth explanation

Quick answer
Verify potassium and the high-alert setup, start insulin, monitor closely, then add dextrose without stopping ketone-clearing therapy too early.

Why this is correct
The sequence prevents hypokalemia and infusion error while ensuring that glucose, ketones, electrolytes, and acidosis guide treatment. Dextrose permits continued insulin after glucose falls.

Easy analogy or mental picture
Use a launch checklist: confirm the runway, perform the dual equipment check, launch, watch every gauge, and add fuel support before glucose falls too far.

Memory hook
Threshold, double-check, start, trend, add dextrose.

NCLEX decision rule
For high-alert insulin in DKA, verify eligibility and delivery before starting; continue metabolic monitoring until ketosis and acidosis resolve, not merely until glucose improves.

Why the other choices are wrong
Starting before the potassium and infusion checks risks harm. Adding dextrose or interpreting recovery before scheduled reassessment puts later actions ahead of safety prerequisites.

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

## Clinical scenario

Case update
Potassium replacement raises the level to 3.8 mmol/L. The nurse is preparing the prescribed intravenous insulin infusion.

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_For study reference only. Always follow current clinical guidelines and your institution’s protocols._