A nurse in the emergency department is admitting a client who has diabetic ketoacidosis and a blood glucose level of 800 mg/dL. Which of the following interventions should the nurse initiate first?
Potassium chloride 10 mEq/hr
Bicarbonate by IV infusion
Subcutaneous insulin injections
0.9% sodium chloride 15 mL/kg/hr
The Correct Answer is D
Choice A rationale: While potassium replacement is important in diabetic ketoacidosis, fluid resuscitation to restore intravascular volume, improve renal perfusion, and flush out ketones.
Choice B rationale: Bicarbonate infusion might be considered in severe acidosis, but fluid administration is the priority.
Choice C rationale: The priority intervention for a client with diabetic ketoacidosis and very high blood glucose levels is to initiate fluid resuscitation to restore intravascular volume, improve renal perfusion, and flush out ketones.
Choice D rationale: The first intervention the nurse should initiate is fluid resuscitation with 0.9% sodium chloride at a rate of 15 mL/kg/hr to restore intravascular volume, improve renal perfusion, and flush out ketones.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale: Hypotension is not a common side effect of prednisone use.
Choice B rationale: Prednisone can also suppress the immune system, so the client should avoid immunizations that contain live viruses or bacteria.
Choice C rationale: Prednisone is a corticosteroid that can cause osteoporosis and increase the risk of fractures in long-term use. Therefore, the nurse should instruct the client to consume a diet high in calcium and vitamin D to prevent bone loss and promote bone health.
Choice D rationale: Prednisone use is more likely to cause hyperglycemia rather than hypoglycemia.
Correct Answer is B
Explanation
Choice A rationale: Massaging the site might increase bleeding or cause irritation after subcutaneous injection.
Choice B rationale: Grasping the skin between the thumb and forefinger throughout the injection helps to stabilize the tissue and minimize the risk of injecting the medication into the muscle, which could lead to increased bleeding.
Choice C rationale: Aspiration is not required for subcutaneous injections and might not influence bleeding at the injection site.
Choice D rationale: The Z-track method is typically used for intramuscular injections to prevent medication from leaking into subcutaneous tissue, but it is not appropriate for subcutaneous heparin injections.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.