A nurse is caring for a client with diabetic ketoacidosis (DKA) who came in with a blood glucose of 790 mg/dL. The DKA treatment protocol has been implemented for at least 6 hours. The most recent finger stick blood glucose is 190 mg/dL. Which of the following nursing interventions will the nurse anticipate to do next?

Choice A reason: Continuing isotonic fluids alone is not the next step when blood glucose drops to 190 mg/dL in DKA. Isotonic fluids (e.g., 0.9% saline) are used initially to restore volume, but as glucose nears 200 mg/dL, adding dextrose prevents hypoglycemia while insulin continues to resolve acidosis, making this choice less appropriate. Choice B reason: Discontinuing insulin infusion is incorrect, as DKA requires continuous insulin to correct acidosis and ketosis, even after glucose normalizes. Insulin suppresses ketone production by inhibiting lipolysis and gluconeogenesis, driven by glucagon excess. Stopping insulin prematurely risks worsening acidosis, making this an unsafe intervention. Choice C reason: Monitoring blood glucose every 4 hours is insufficient during active DKA treatment, where hourly checks are standard to titrate insulin and fluids. Glucose at 190 mg/dL requires adding dextrose to prevent hypoglycemia while continuing insulin, making frequent monitoring and intervention more critical than this choice suggests. Choice D reason: Starting dextrose 5% solution intravenously is the correct next step when blood glucose reaches 190 mg/dL in DKA. This prevents hypoglycemia as insulin continues to correct acidosis and ketosis, maintaining glucose levels while addressing anion gap closure, driven by insulin’s role in suppressing ketone production and restoring metabolic balance.