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. Hypocalcemia: Hydrochlorothiazide is not typically associated with lowering calcium levels. Hypocalcemia is not a common adverse effect of this medication.
B. Hypernatremia: Hydrochlorothiazide is a diuretic that increases urination, leading to the loss of water and sodium. While it can cause sodium depletion, it's less likely to result in hypernatremia, which refers to high sodium levels in the blood.
C. Hypokalemia: Hydrochlorothiazide is a thiazide diuretic that can increase the excretion of potassium in the urine. Hypokalemia (low potassium levels) is a known adverse effect of this medication due to its action on the kidneys leading to potassium loss.
D. Hypermagnesemia: Hydrochlorothiazide does not typically cause an increase in magnesium levels. It's more likely to cause magnesium loss through increased urination, potentially leading to hypomagnesemia (low magnesium levels) rather than hypermagnesemia.

A. Obtain a prescription for an alternative antibiotic B. Administer the clindamycin using a desensitization schedule. C. Premedicate the client with epinephrine before administering the antibiotic D. Give the client the prescribed pose of the clindamycin

Correct Answer is D

Explanation

A. Obtain a prescription for an alternative antibiotic:
Clindamycin is generally safe for penicillin-allergic clients there is no need for an alternative antibiotic.
B. Administer the clindamycin using a desensitization schedule:
Using a desensitization schedule is a specialized procedure typically reserved for certain situations and performed in a controlled environment. It is not a standard approach for administering antibiotics, and in this case, obtaining an alternative antibiotic is a more appropriate and straightforward solution.
C. Premedicate the client with epinephrine before administering the antibiotic:
Premedicating with epinephrine is not a routine practice for preventing allergic reactions to antibiotics. While epinephrine may be used in severe allergic reactions, it's not a preemptive measure in this context. It's important to address the underlying issue by avoiding the allergen (penicillin class) and using an alternative antibiotic.
D. Give the client the prescribed dose of the clindamycin:
Clindamycin is generally safe for penicillin-allergic clients since it belongs to the lincosamide class and does not share the beta-lactam ring structure responsible for allergic reactions to penicillins.

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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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Explanation

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