A nurse in the emergency department is admitting a client who has diabetic ketoacidosis and a blood glucose level of 100 mg/dl. Which of the following interventions should the nurse initiate first?
Potassium chloride 10 mEq/hr
Bicarbonate by IV infusion
Subcutaneous insulin injections
0.99% sodium chloride 15 mL/kg/hr
The Correct Answer is D
A. Potassium chloride 10 mEq/hr:
While potassium replacement is crucial in DKA, initiating it before fluid resuscitation can lead to further complications. Insulin administration can drive potassium back into cells, potentially causing hypokalemia. Fluid resuscitation helps address dehydration and electrolyte imbalances.
B. Bicarbonate by IV infusion:
Bicarbonate therapy is generally reserved for severe cases of acidosis, and its use in DKA is controversial. In this scenario, the blood glucose level is not significantly elevated, and the focus should be on fluid resuscitation and insulin administration.
C. Subcutaneous insulin injections:
While insulin is a critical component of DKA management, it should be administered intravenously for faster and more precise control of blood glucose levels. Subcutaneous insulin injections are not the initial route of administration in DKA.
D. 0.9% sodium chloride 15 mL/kg/hr:
This is the correct answer. The first step in DKA management is fluid resuscitation with isotonic saline (0.9% sodium chloride). The goal is to address dehydration, restore intravascular volume, and improve perfusion. Insulin therapy and other interventions follow fluid resuscitation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Urticaria (hives): Urticaria is a manifestation of an allergic reaction, which can occur during a transfusion reaction. If the client develops urticaria, it suggests an allergic response, and epinephrine may be administered to manage severe allergic reactions.
B. Distended jugular vein: Distended jugular veins may be associated with fluid overload or cardiovascular issues, but it is not a typical indication for administering epinephrine during a blood transfusion reaction.
C. Bounding pulse: A bounding pulse may be associated with increased cardiac output but is not typically an indication for epinephrine administration during a blood transfusion reaction.
D. Confusion: Confusion is a neurological symptom and is not a typical indication for administering epinephrine during a blood transfusion reaction. Neurological symptoms may suggest other complications that need appropriate interventions.
Correct Answer is C
Explanation
A. A vein that feels hard to the touch:
A vein that feels hard to the touch may indicate thrombosis or inflammation and is not a suitable site for catheter insertion.
B. A vein in the client's dominant arm:
The choice of arm may depend on the client's preference, but it is not a strict rule. The nurse can choose a suitable vein in either arm based on factors such as accessibility and vein condition.
C. A vein proximal to the previous site:
This is the correct answer. Placing the catheter proximal (above or upstream) to the previous site helps minimize the risk of complications such as infiltration and thrombophlebitis at the new site. It allows for optimal vein health and reduces the likelihood of complications associated with repeated punctures in the same area.
D. A vein on the client's wrist:
Veins on the wrist may be smaller and more prone to complications. It is generally recommended to choose larger, more accessible veins for catheter insertion.
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