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 C

Explanation

A. Stroke volume: While stroke volume is an important parameter in assessing cardiac function, it may not directly guide the titration of nitroprusside infusion. Blood pressure is a more immediate indicator of the drug's effect on vasodilation.
B. Urine output: Nitroprusside primarily affects the vascular system and is not directly associated with urine output. Monitoring urine output is crucial in assessing renal function, but it is not the primary parameter for titrating a nitroprusside infusion.
C. Blood pressure (Correct Answer): Nitroprusside acts as a direct vasodilator, and its primary effect is on blood vessels, leading to a reduction in blood pressure. Therefore, monitoring blood pressure is essential to titrate the infusion to achieve the desired therapeutic effect.
D. Cardiac output: While nitroprusside's vasodilatory effect may influence cardiac output indirectly, blood pressure is a more immediate and specific parameter to guide the titration of the infusion. Nitroprusside is often titrated to reach a target blood pressure range in hypertensive emergencies.

A. Dark amber urine B. Decreased skin turgor C. Increased bowel sounds D. Pink, frothy sputum

Correct Answer is D

Explanation

A. Dark amber urine:
Dark amber urine is not typically an adverse effect of receiving 0.9% sodium chloride solution. It may be a sign of concentrated urine, dehydration, or the presence of certain substances, but it is not a direct adverse effect of the solution itself.
B. Decreased skin turgor:
Decreased skin turgor is a clinical manifestation of dehydration and is not an adverse effect of 0.9% sodium chloride solution. The solution is administered to address dehydration and restore fluid balance.
C. Increased bowel sounds:

Increased bowel sounds are not an adverse effect of 0.9% sodium chloride solution. Bowel sounds are influenced by various factors, including the presence of gas and peristalsis, but they are not directly related to the administration of this isotonic solution.
D. Pink, frothy sputum:
This is the correct answer. Pink, frothy sputum is a potential sign of pulmonary edema, which can be associated with fluid overload. Administering 0.9% sodium chloride solution too rapidly or in excessive amounts can lead to fluid overload and pulmonary edema.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to titrate a continuous nitroprusside infusion for a client. The nurse should plan to titrate the infusion according to which of the following assessments?

Correct Answer is C

Explanation

A nurse is caring for a client who is receiving 0.9% sodium chloride solution to treat dehydration. Which of the following findings should the nurse identify as an adverse effect of the solution?

Correct Answer is D

Explanation

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