A client is admitted with diabetic ketoacidosis (DKA).
The nurse should anticipate administering which of the following intravenous fluids (Select all that apply).
0.45% sodium chloride solution.
0.9% sodium chloride solution.
5% dextrose in water solution.
Lactated Ringer’s solution.
Regular insulin infusion.
Correct Answer : A,B,C,E
Choice A reason: This hypotonic saline solution is often used after initial resuscitation, especially when the patient’s serum sodium is normal or elevated. It helps replace intracellular fluid losses and provides ongoing hydration without excessively increasing sodium levels. It is typically administered once the initial intravascular volume is restored with isotonic fluids.
Choice B reason: This isotonic saline solution is the first-line intravenous fluid used in DKA. It helps expand intravascular volume quickly, restore tissue perfusion, and correct hypovolemia caused by osmotic diuresis. It is given initially as a bolus, followed by continuous infusion until the patient is stabilized.
Choice C reason: This dextrose-containing solution is introduced once blood glucose falls to approximately 200–250 mg/dL. At this point, insulin therapy must continue to clear ketones and correct acidosis, but dextrose is added to prevent hypoglycemia. It is usually combined with saline (e.g., D5 0.45% NS) to balance hydration and glucose support.
Choice D reason: This balanced electrolyte solution is not typically the preferred fluid in DKA management because the lactate component may complicate interpretation of acid–base status. Although it can expand volume, it is generally avoided in favor of saline solutions that more directly address dehydration and electrolyte imbalance in DKA.
Choice E reason: This form of insulin is the only type used intravenously in DKA. A continuous infusion of regular insulin is essential to reduce blood glucose, suppress ketone production, and correct metabolic acidosis. It is carefully titrated with close monitoring of electrolytes, especially potassium, since insulin drives potassium into cells and can cause hypokalemia.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Hyponatremia is a condition where the serum sodium level is below 135 mEq/L, which can affect the normal functioning of cells, muscles, and organs.
Administering intravenous fluids with a high sodium content can help restore the sodium balance and prevent complications such as confusion, seizures, and coma.
Choice A is wrong because encouraging the patient to consume a low-sodium diet would worsen the hyponatremia and increase the risk of electrolyte imbalance.
Choice C is wrong because administering a diuretic medication to increase urine output would cause further fluid and sodium loss and exacerbate the hyponatremia.
Choice D is wrong because encouraging the patient to increase fluid intake would dilute the sodium concentration and lower the serum sodium level.
Correct Answer is A
Explanation
Sodium is the major extracellular electrolyte in the body.
It is responsible for maintaining the extracellular fluid volume, and also for regulation of the membrane potential of cells.
Sodium is exchanged along with potassium across cell membranes as part of active transport.
Choice B is wrong because potassium is mainly an intracellular ion.
It is important for nerve and muscle function, but it is not the predominant electrolyte in the extracellular fluid.
Choice C is wrong because calcium is not the major electrolyte in the extracellular fluid.
Calcium is mostly found in bones and teeth, where it forms a mineral reserve with phosphate.
Calcium also plays a role in muscle contraction, blood clotting, and enzyme activity.
Choice D is wrong because magnesium is not the major electrolyte in the extracellular fluid.
Magnesium is mostly found in bones, where it helps to stabilize the structure of ATP2.
Magnesium also participates in enzyme reactions, nerve and muscle function, and protein synthesis.
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