# Stage 6 — Evaluate outcomes. Review the metabolic trend and answer both questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568683&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

Stage 6 — Evaluate outcomes. Review the metabolic trend and answer both questions.

| Time | Data |
| --- | --- |
| Arrival | Glucose 462; beta-hydroxybutyrate 5.8; pH 7.19; bicarbonate 10; potassium 5.4 |
| 2 hours | Glucose 356; potassium 3.2; insulin held while potassium is replaced |
| 6 hours | Glucose 238; beta-hydroxybutyrate 2.1; pH 7.27; potassium 3.9; dextrose added while insulin continues |
| 12 hours | Glucose 178; beta-hydroxybutyrate 0.4; pH 7.32; bicarbonate 19; tolerating oral intake |

Q1. Which interpretation is best supported at 12 hours?

Glucose improved but ketoacidosis is worsening
Ketosis and acidosis have resolved while glucose remains controlled
Potassium replacement caused a new hyperglycemic crisis
A normal oxygen saturation proves metabolic recovery

Q2. Which transition action is most important before stopping intravenous insulin?

Restart the uninspected pump immediately
Stop all insulin once glucose is below 200 mg/dL
Wait until the next outpatient visit to prescribe basal insulin
Administer scheduled basal subcutaneous insulin with the required overlap

## Explanation

Falling beta-hydroxybutyrate with recovery of pH and bicarbonate indicates DKA resolution. Glucose may normalize earlier, so insulin continues with dextrose as needed. Basal subcutaneous insulin must overlap the intravenous infusion to reduce rebound ketoacidosis.

## In-depth explanation

Quick answer
The ketone and acid-base trend shows resolution; overlap basal insulin before stopping the infusion.

Why this is correct
DKA resolution depends on ketone clearance and correction of acidosis, not glucose alone. A planned insulin overlap prevents an insulin-free interval and rebound ketogenesis.

Easy analogy or mental picture
The intravenous and basal insulin courses should overlap like two bridge sections. Removing the first before the second is in place leaves a gap.

Memory hook
Close ketones, correct acid, overlap insulin.

NCLEX decision rule
Evaluate DKA with metabolic endpoints and ensure basal coverage before discontinuing intravenous insulin.

Why the other choices are wrong
Glucose can fall before DKA resolves, oxygen saturation is not a metabolic endpoint, and an uninspected pump or delayed basal plan can recreate the original insulin gap.

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

## Clinical scenario

Case update
Fluids, potassium replacement, and intravenous insulin were administered according to protocol. The team is evaluating resolution and transition.

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