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Photo of Ala A.Ala A.RN, Passed NCLEX-RN · Hemodialysis
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Adolescent With New-Onset Diabetic KetoacidosisItem 1 of 6
Emergency department arrival

16-year-old brought in by a parent after 3 days of increasing thirst, frequent urination, and fatigue, and this morning was difficult to wake and vomited twice No known history of diabetes

FindingValue
Weight60 kg
On arrivallethargic but arousable, Kussmaul respirations (deep and rapid), fruity breath odor
Temperature37.1 C (98.8 F), heart rate 128, blood pressure 96/58, respirations 32, oxygen saturation 98% on room air
Mucous membranesdry, skin turgor decreased, capillary refill 3 seconds
NCLEX-RN TEST | NCLEXPace StudentCase item 1 of 6

Fill in the blank. Record your answer to one decimal place.

The provider orders a regular insulin infusion at 0.1 units/kg/hr for this client, who weighs 60 kg. At what rate, in units per hour, should the nurse set the pump? Record your answer to one decimal place. ____ units/hr

Type the numeric answer. Round per the question's instructions.
✓ Correct: full credit
Explanation

Overview

Multiply the prescribed rate by the client’s weight: 0.1 units/kg/hr × 60 kg = 6 units/hr. Enter 6.0 units/hr in the requested format. In this adolescent’s DKA protocol, insulin begins after initial fluid resuscitation and confirmation that potassium meets the prescribed threshold; no insulin bolus is ordered.

Nursing key points
The prescribed 0.1 units/kg/hr rate gives 6 units/hr for a 60 kg client.
Verify the insulin concentration and pump programming, and confirm that the prerequisites for starting insulin are met.
Monitor glucose hourly and follow serial potassium, acid-base status, and neurologic assessments during treatment.

Answer analysis

Step in the calculationAnswerWhy
Weight-based rate ordered0.1 units/kg/hrThis is the rate prescribed for this client. Pediatric DKA infusion rates are selected according to the treatment protocol.
Rate multiplied by the weight6.0 units/hrMultiplying 0.1 units/kg/hr by 60 kg gives 6 units/hr, written as 6.0 units/hr for this question.
Absence of an insulin bolusNo bolusThe order explicitly excludes a bolus, consistent with pediatric DKA practice. Use the prescribed continuous infusion after initial fluids.
Potassium confirmed before insulinRequired firstInsulin shifts potassium into cells and can worsen hypokalemia. Confirm the potassium result and replacement plan before starting the infusion.
Ongoing monitoringHourly glucoseHourly measurements track the glucose decline and identify a need for protocol-based insulin or dextrose adjustments.
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I studied for six months and NCLEXPace's adaptive questions were exactly what I needed. I passed at 85 questions on my first attempt.

Photo of Ala A.Ala A.RN, Passed NCLEX-RN · Hemodialysis
🇨🇦 Ontario, Canada
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Cheat Sheets

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Critical Lab ValuesSample
LabNormal range
Sodium (Na⁺)135–145 mEq/L
Potassium (K⁺)3.5–5.0 mEq/L
Calcium (Ca²⁺)9.0–10.5 mg/dL
Magnesium (Mg²⁺)1.3–2.1 mEq/L
Glucose (fasting)70–100 mg/dL
Platelets150,000–400,000/mm³
WBC5,000–10,000/mm³
INR (on warfarin)2.0–3.0
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