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

Answer and Explanation

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.

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Correct Answer is B

Explanation

A. Potassium 4.2 mEq/L: While potassium levels should be monitored during amitriptyline therapy, the value of 4.2 mEq/L is within the normal range. There is no immediate concern based on this potassium level.

B. Total bilirubin 1.5 mg/dL

Amitriptyline, a tricyclic antidepressant, can sometimes cause hepatotoxicity, which may manifest as elevated liver enzymes or bilirubin levels. Therefore, any abnormality in liver function tests, such as total bilirubin, should be reported to the provider for further evaluation and management.

C. WBC count 5,000/mm³: The white blood cell count is not a commonly monitored parameter for amitriptyline, and the value of 5,000/mm³ is within the normal range. There is no immediate concern based on this WBC count.
D. Hct 44:The hematocrit (Hct) level is related to the percentage of red blood cells in the blood.A value of44%falls within the normal range for hematocrit. There’s no immediate concern related to amitriptyline use based on this result either.

A. A client received 0900 medications at 0930. B. A client who has asthma was administered tiotropium via inhalation. C. A client received a blood transfusion with dextrose 5% in water. D. A client received an infusion of lipids through a central line

Correct Answer is C

Explanation

A. A client received 0900 medications at 0930:
This situation involves a medication administration error where the medications were administered later than the scheduled time. An incident report should be completed to document the error, investigate the circumstances, and implement measures to prevent recurrence.
B. A client who has asthma was administered tiotropium via inhalation:
Tiotropium is an appropriate medication for asthma. As long as it was administered according to the prescribed guidelines, there is no need for an incident report.
C. A client received a blood transfusion with dextrose 5% in water:
This situation involves a significant medication error, as dextrose 5% in water is not the appropriate solution for a blood transfusion. An incident report should be completed to document the error, investigate the circumstances, and implement measures to prevent recurrence.
D. A client received an infusion of lipids through a central line:
If the infusion of lipids through a central line was ordered and administered appropriately, there is no need for an incident report. Lipid infusions are commonly administered through central lines when indicated.

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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?

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Naxlex Comprehensive Predictor Exams

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