# 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. Which actions belong in the immediate plan? Select exactly 4 responses. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=603003&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. Which actions belong in the immediate plan? Select exactly 4 responses. Select exactly 4 responses. 1 Begin authorized isotonic fluid resuscitation with renal and volume reassessment. 2 Start protocol-directed insulin and potassium management and add dextrose when needed so insulin can continue until ketonemia resolves. 3 Transition to subcutaneous insulin when glucose falls below 180 mg/dL even if beta-hydroxybutyrate remains elevated. 4 Hold the SGLT2 inhibitor and document the suspected medication-associated event. 5 Stop dextrose and reduce insulin when glucose reaches 200 mg/dL even if acidosis persists. 6 Obtain ordered cultures and administer prescribed antimicrobials without avoidable delay. ## Explanation Safe care stops the suspect medication, restores circulation, uses insulin with electrolyte and dextrose support until ketoacidosis resolves, and treats the precipitating infection. Glucose alone and urine ketones do not establish resolution. ## In-depth explanation Quick answer Use hold, hydrate, insulin plus potassium, treat the trigger, and reassess ketonemia. Why this is correct Dextrose may be needed while insulin continues because plasma glucose can normalize before ketones and acidosis resolve. Urine ketones can lag or appear worse as beta-hydroxybutyrate converts to acetoacetate. 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. 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Always follow current clinical guidelines and your institution’s protocols._