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?

Subcutaneous insulin injections.

Bicarbonate by IV infusion.

0.9% sodium chloride 15 m/kg/hr.

Potassium chloride 10 mEq/hr.

Answer and Explanation

The Correct Answer is C

The first intervention for a client with diabetic ketoacidosis and a blood glucose level of 800 mg/dL should be to initiate fluid replacement therapy with 0.9% sodium chloride at a rate of 15 mL/kg/hr.

This will help to replace fluids lost through excessive urination and to dilute the excess sugar in the blood.

Choice A is wrong because subcutaneous insulin injections are not the first intervention for diabetic ketoacidosis.

Insulin therapy is generally given intravenously.

Choice B is wrong because bicarbonate by IV infusion is not the first intervention for diabetic ketoacidosis.

Choice D is wrong because potassium chloride at a rate of 10 mEq/hr is not the first intervention for diabetic ketoacidosis.

Electrolyte replacement may be necessary to replace minerals such as sodium, potassium, and chloride, but this is not the first intervention 2.

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Correct Answer is C

Explanation

A. Assist the client to a left lateral position.
- This is generally used for clients at risk of aspiration, and it's not indicated based on the lithium level.
B. Implement fluid restrictions.
- Fluid restrictions are usually implemented when there is a risk of fluid overload or hyponatremia, and not in this case. In fact, dehydration can raise lithium levels to toxic levels, so proper hydration is important.
C. Request a dosage increase from the provider.
- While 0.6 mEq/L is within the therapeutic range, some providers may want to see a level slightly higher for maintenance. So requesting a dosage increase from the provider is the correct action.
D. Prepare the client for hemodialysis.
- Hemodialysis is used to remove lithium from the blood in cases of severe lithium toxicity, which is indicated by levels significantly higher than 1.5 mEq/L. This is not needed when the lithium level is 0.6 mEq/L.

A. Increased pulse rate. B. Increased blood pressure. C. Decreased temperature. D. Decreased respiratory rate.

Correct Answer is A

Explanation

The correct answer is choice A. Increased pulse rate.

An aPTT of 90 seconds is much higher than the normal range of 30-40 seconds, which means the blood takes longer to clot and the client is at risk of bleeding. An increased pulse rate is a sign of blood loss and shock.

Choice B is wrong because increased blood pressure is not a sign of bleeding, but rather a sign of hypertension or stress.

Choice C is wrong because decreased temperature is not a sign of bleeding, but rather a sign of hypothermia or infection.

Choice D is wrong because decreased respiratory rate is not a sign of bleeding, but rather a sign of respiratory depression or sedation.

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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?

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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?