A nurse is calculating fluid input for a client who is receiving a continuous IV infusion of 0.9% sodium chloride at 125 mL/hr and cefazolin 50 mL IV bolus every 4 hr. How many mL did the client receive per IV infusion over the past 24 hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Rationale for Correct Choices:

• 0.9% sodium chloride should be administered first to address dehydration and restore circulatory volume. Fluid resuscitation is the priority in managing diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar state (HHS) to stabilize the patient and prevent complications such as shock or renal failure.
• Insulin should follow the fluid resuscitation to lower blood glucose levels and correct ketosis. Insulin is crucial for reversing the metabolic abnormalities in DKA or HHS and should be started after initial fluid therapy to prevent worsening hypokalemia.

Rationale for Incorrect Choices:

• Magnesium supplementation should not be administered as the first step. Magnesium sulfate is typically given if hypomagnesemia is confirmed or if the patient exhibits signs of magnesium deficiency, but it is not a priority in the immediate management of DKA.
• Acetaminophen is used for pain relief. It should not be the first intervention, as fluid resuscitation and insulin therapy must be initiated to stabilize the patient's condition. Pain management can be addressed after the metabolic crisis is under control.
• Ondansetron is used to manage nausea, which is common in DKA, but it is not the first priority. The nurse should focus on addressing the client’s metabolic disturbances, such as dehydration and hyperglycemia, before using antiemetic therapy.
• Potassium should only be administered if the potassium level drops below 3.3 mEq/L. The current potassium level is 5.5 mEq/L which higher than the normal range. It should be monitored closely as insulin is administered, as it can drive potassium into the cells.

Rationale:

A. Crepitus at the puncture site: Crepitus, or the sensation of air under the skin, may indicate subcutaneous emphysema, which is a complication that can occur after thoracentesis. It is not a normal finding and should be reported immediately.

B. Dry, nonproductive cough: A dry, nonproductive cough is not a typical finding immediately following thoracentesis. Coughing may be associated with post-procedure irritation but should not be expected as a common outcome.

C. Increased lung expansion: Increased lung expansion is the desired outcome after thoracentesis. The procedure removes excess pleural fluid, allowing the lung to expand more fully. This is a positive result that should be expected as the client recovers.

D. Rapid, shallow respirations: Rapid, shallow respirations can indicate respiratory distress, which could signal a complication such as pneumothorax. This is not an expected finding and requires immediate evaluation and intervention.