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A nurse is caring for a client in the emergency department.

Complete the following sentence by using the lists of options.

The nurse should administer a total of

0.9% sodium chloride in the first hour, and then each subsequent hour.
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Rationale for Correct Choices

• 1 L of 0.9% sodium chloride in the first hour: In diabetic ketoacidosis (DKA), the initial priority is rapid fluid resuscitation to restore intravascular volume and improve tissue perfusion. Administering 1 L of isotonic saline during the first hour helps correct hypotension, tachycardia, and dehydration caused by osmotic diuresis. This bolus stabilizes the client and prepares for subsequent insulin therapy.

• 500 mL each subsequent hour: After the initial fluid bolus, continuing isotonic saline at a slower rate (typically 500 mL per hour) maintains hydration, supports renal perfusion, and gradually corrects electrolyte imbalances. This stepwise approach prevents fluid overload while addressing ongoing losses from polyuria and vomiting.

Rationale for Incorrect Choices

• 2 L in the first hour: Administering 2 L rapidly can cause fluid overload, pulmonary edema, or worsening cardiac strain, especially in clients with potential comorbidities such as hypertension or cardiac dysfunction. A controlled initial bolus of 1 L is safer and evidence-based.

• 500 mL in the first hour: Starting with only 500 mL is insufficient for correcting significant hypovolemia in DKA. Rapid intravascular volume replacement is necessary to prevent shock and improve perfusion.

• 100 mL each subsequent hour: A rate of 100 mL/hr is too slow to meet ongoing fluid needs in a dehydrated client with DKA. Inadequate fluid replacement prolongs hypovolemia, delays renal recovery, and worsens electrolyte imbalances.

• 1 L each subsequent hour: Maintaining a rate of 1 L/hr after the initial bolus may lead to fluid overload, especially in older adults or those with cardiac or renal compromise. A slower maintenance rate of 500 mL/hr balances hydration with safety.


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Related Questions

Correct Answer is C

Explanation

A. Steatorrhea: Steatorrhea, or fatty stools, is more commonly associated with malabsorption disorders such as pancreatic insufficiency or celiac disease. It is not a typical finding in colon cancer.

B. Elevated hemoglobin: Colon cancer is more likely to cause chronic blood loss, which can lead to anemia and low hemoglobin, rather than an elevated level. High hemoglobin is not an expected manifestation.

C. Hematochezia: Hematochezia, or the passage of bright red blood in the stool, is a common symptom of colon cancer, especially when tumors are located in the distal colon or rectum. It reflects bleeding from the tumor site and is an important clinical indicator.

D. Weight gain: Weight gain is not expected with colon cancer; instead, unintentional weight loss is more common due to decreased appetite, altered metabolism, and the effects of the malignancy.

Correct Answer is B

Explanation

A. Airborne: Airborne precautions are used for infections transmitted via tiny droplet nuclei that remain suspended in the air, such as tuberculosis or measles. Haemophilus influenzae type B is not transmitted through airborne particles, so these precautions are not required.

B. Droplet: Droplet precautions are indicated for infections spread by large respiratory droplets, such as Haemophilus influenzae type B. These precautions include wearing a mask when within close proximity to the client to prevent transmission during coughing, sneezing, or talking.

C. Contact: Contact precautions are used for infections transmitted by direct or indirect contact with the client or contaminated surfaces, such as MRSA or C. difficile. H. influenzae type B is not primarily spread via contact, these measures are not sufficient alone.

D. Protective environment: Protective environment precautions are designed to protect immunocompromised clients from infection, using positive pressure rooms and specialized airflow. These precautions are not necessary for preventing the spread of H. influenzae type B to healthcare providers.

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