A nurse is caring for a client who reports abdominal pain.

The nurse is caring for a client who has abdominal pain. Which of the following actions should the nurse take? Select all that apply.

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.

A. "In the last day, I have had a severe headache and pain around my right eye.": A sudden severe headache with eye pain can indicate acute angle-closure glaucoma, which requires immediate intervention to prevent rapid and permanent vision loss. This condition causes a dangerous rise in intraocular pressure and is a medical emergency.

B. "I can't seem to get reading materials far enough away to see the words.": This statement suggests presbyopia, a common age-related change in which the lens becomes less elastic. While bothersome, it is not urgent and can be managed with corrective lenses. It does not pose a threat to the client’s immediate vision.

C. "I've noticed that there is a gray ring around the colored part of my eye.": A gray ring, known as arcus senilis, is a normal finding in older adults caused by lipid deposits. It does not impair vision or require urgent intervention. This condition is benign and does not indicate acute pathology.

D. "I'm having more difficulty telling the difference between blues and greens.": Difficulty distinguishing colors, especially blue-green tones, is a normal part of aging due to changes in the lens. While it may affect daily activities, it does not indicate an emergency or serious ocular disease.