A client with diabetic ketoacidosis (DKA) is receiving a continuous intravenous infusion o… — NCLEX-RN

A client with diabetic ketoacidosis (DKA) is receiving a continuous intravenous infusion of regular insulin. Which nursing interventions are appropriate when managing this parenteral therapy? Select all that apply.

Prime the intravenous tubing with a portion of the insulin solution prior to connecting it to the client.Answer
Add a 5% dextrose solution to the continuous intravenous fluids when the client's blood glucose level falls to $250 \text{ mg/dL}$ ( $13.9 \text{ mmol/L}$ ).Answer
Monitor serum potassium levels frequently and anticipate potassium replacement even if the initial level is within normal limits.Answer
D
Connect intermittent intravenous antibiotic piggybacks into the insulin infusion line to minimize the number of venipunctures.
E
Stop the intravenous insulin infusion immediately once the blood glucose reaches $150 \text{ mg/dL}$ ( $8.3 \text{ mmol/L}$ ) as the priority action to prevent severe hypoglycemia.
F
Calculate the continuous insulin infusion rate based on the client's ideal body weight rather than actual body weight.

Answer

The appropriate interventions include priming the tubing with insulin solution, adding dextrose to IV fluids when glucose drops to

250 \text{ mg/dL}

, and closely monitoring and replacing serum potassium.

Regular insulin is a high-alert medication requiring specific parenteral safeguards. Priming the plastic tubing with the insulin mixture is mandatory because insulin adsorbs to polyvinyl chloride; failing to prime can lead to subtherapeutic delivery. Adding a dextrose-containing solution when the blood glucose falls to approximately

250 \text{ mg/dL}

(

13.9 \text{ mmol/L}

) is a standard protocol to prevent hypoglycemia while allowing the insulin to continue suppressing ketone production. Additionally, because insulin facilitates the transport of potassium into cells, serum potassium levels will drop rapidly. The nurse must proactively monitor and replace potassium to prevent fatal dysrhythmias, even if the baseline potassium is normal.

Step-by-Step Solution

Analyze the physical properties of regular insulin in an intravenous delivery system.

Insulin molecules bind to plastic tubing.

Saturating the tubing by priming it with the insulin solution prevents initial underdosing.

Evaluate the physiological effects of continuous intravenous insulin on electrolytes and glucose.

Insulin lowers blood glucose rapidly and shifts potassium intracellularly.

This necessitates the proactive addition of dextrose at

250 \text{ mg/dL}

to prevent hypoglycemia and requires strict potassium monitoring to prevent dysrhythmias.

Assess safety and compatibility requirements for high-risk parenteral therapies.

Insulin requires a dedicated intravenous line and is dosed based on actual body weight.

Using a dedicated line prevents incompatibility and accidental boluses, while actual body weight calculations ensure the dose is sufficient to reverse ketoacidosis.

Key Concept

Management and safety principles of continuous intravenous insulin therapy

Question

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Step-by-Step Solution

Key Concept

Common Mistakes

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