A nurse is caring for a client who weighs 190 lb and is receiving total parenteral nutrition. If the RDA of protein is 0.8 g/kg of body weight, how many grams of protein should the client receive daily? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A. Initiate cardiac monitoring
Cardiac monitoring is essential because the client has hyperkalemia (potassium 5.5 mEq/L), which increases the risk of life-threatening arrhythmias. Monitoring will help detect any cardiac changes during treatment, especially as potassium levels may fluctuate with insulin therapy and fluid resuscitation.
B. 0.9% sodium chloride at 15 mL/kg/hr for 1 hr and then reduce to 10 mL/kg/hr
Aggressive fluid resuscitation with isotonic saline is the cornerstone of DKA management to correct dehydration and improve perfusion. The initial rate of 15 mL/kg/hr is appropriate, given the client's signs of dehydration (slight tenting of skin, low blood pressure, and tachycardia). The reduction in rate after initial resuscitation prevents fluid overload.
C. Blood glucose checks every 4 hr
Frequent blood glucose monitoring (typically hourly) is required in DKA management, not every 4 hours, to closely monitor response to insulin therapy and adjust the infusion rate as needed.
D. Insert indwelling urinary catheter
While monitoring urine output is important, a catheter is not routinely indicated unless the client cannot void, is hemodynamically unstable, or requires strict measurement of output.
E. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L
Potassium replacement is anticipated but should be part of a protocol-based approach. Potassium is typically added to IV fluids once levels fall below 5.0 mEq/L and the client is voiding adequately.
F. Regular insulin 20 units subcutaneously
Subcutaneous insulin is not appropriate for managing DKA due to its delayed onset and prolonged action compared to IV insulin, which allows for precise titration.

G. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L
Continuous IV insulin is the standard treatment for DKA to reduce blood glucose levels and correct ketoacidosis. Insulin therapy should not begin until potassium is confirmed to be above 3.3 mEq/L to avoid exacerbating hypokalemia, which could lead to arrhythmias.

H. Dextrose 5% in water (D5W) intravenous at 5 mL/kg/hr for 4 hr
Dextrose-containing fluids are added only after blood glucose decreases to approximately 200-250 mg/dL to prevent hypoglycemia during ongoing insulin therapy. At this stage, D5W is not yet appropriate.

A. While IV fluids are important to prevent renal failure due to myoglobin release, the priority action is to assess for any immediate life-threatening issues, such as cardiac arrhythmias, which are common after electrical shock.

B. Obtaining an ECG is the first priority because electrical shock can cause cardiac arrhythmias, including life-threatening ones like ventricular fibrillation. Immediate monitoring of the heart's electrical activity is critical to assess the need for intervention.

C. Changing dressings is important for wound care, but it is not the priority action. The client’s immediate survival depends on monitoring and stabilizing the heart.

D. Administering pain medication is important for comfort but should not be the first priority. The focus should be on stabilizing the client and addressing any immediate life-threatening issues.