Adult Critical Care Specialty (ACCS) Practice Exam

In this scenario, the patient's elevated glucose level suggests possible hyperglycemia, which is often seen in conditions like uncontrolled diabetes or diabetic ketoacidosis (DKA). The bicarbonate level indicates metabolic acidosis, as a bicarbonate level of 15 mEq/L is below the normal range. Insulin is the cornerstone of initial treatment in cases involving hyperglycemia, especially when metabolic acidosis is present. Administering insulin will help reduce the blood glucose levels by promoting glucose uptake into the cells, simultaneously addressing the underlying issue contributing to metabolic acidosis. In cases of DKA, which is often indicated by elevated glucose and low bicarbonate levels, insulin therapy not only lowers blood sugar but also aids in the correction of acidosis through the reduction of ketone production. While fluids are also important in the management of such patients, in instances of significant metabolic derangement, the administration of insulin takes priority as it directly addresses the cause of the elevated glucose and the resulting symptoms. Furthermore, sodium bicarbonate is typically reserved for severe acidosis with a pH below 7.0, and calcium gluconate is not indicated for this metabolic situation. Thus, initiating treatment with insulin is the most appropriate first step in this case.