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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Administer more than one pill to the client at a time: Administering more than one pill at a time may increase the risk of choking, especially for individuals with dysphagia. It's generally advisable to administer one medication at a time to ensure proper swallowing.
B. Tilt the client's head back when administering the medications: Tipping the head backward can increase the risk of aspiration (inhalation of medication into the airways). It is recommended to keep the head in a neutral or slightly forward position to facilitate swallowing.
C. Place the medications on the back of the client's tongue: Placing medications on the back of the tongue may trigger the gag reflex and increase the risk of aspiration. Medications should be placed on the front of the tongue to allow for better control and coordination of swallowing.
D. Mix the medications with a semisolid food for the client (Correct Answer): Mixing medications with a semisolid food, often referred to as "food thickening," can be beneficial for clients with dysphagia. This helps make the medications easier to swallow and reduces the risk of choking or aspiration. However, it is important to check with the healthcare provider or pharmacist to ensure compatibility with specific medications.
Correct Answer is D
Explanation
A. Inform the client there is a prescription available if needed:
This response does not address the urgency indicated by the prescription stating "NOW." It is essential to take immediate action when the prescription indicates an urgent administration.
B. Notify the pharmacy to send the medication immediately:
While timely medication administration is crucial, contacting the pharmacy directly without clarification from the provider may lead to misinterpretation or errors. It's important to confirm the prescription details first.
C. Administer the medication within 90 minutes:
The prescription indicating "NOW" suggests a need for more immediate administration than within 90 minutes. Waiting for 90 minutes may not be in line with the urgency implied by the prescription.
D. Contact the provider to clarify the prescription:
This is the correct action. The prescription is ambiguous, and the nurse should seek clarification from the provider regarding the urgency of administration, the reason for the medication, and any other pertinent details to ensure safe and appropriate care.
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