A nurse is caring for a client with diabetic ketoacidosis (DKA). Which of the following interventions is the priority?

Choice A reason: Bradypnea, or slow respiratory rate, is not typical in hypovolemic shock. The body compensates for reduced blood volume by increasing respiratory rate (tachypnea) to enhance oxygen delivery to tissues. This compensates for decreased oxygen-carrying capacity due to blood loss. Bradypnea would indicate a failure of compensatory mechanisms, which is not characteristic of hypovolemic shock’s early stages.

Choice B reason: Hypotension is an expected finding in hypovolemic shock due to decreased blood volume, reducing cardiac output and systemic perfusion pressure. The body activates the sympathetic nervous system, causing vasoconstriction and tachycardia to compensate, but blood pressure remains low. This reflects inadequate circulating volume, leading to impaired tissue perfusion and potential organ dysfunction if untreated.

Choice C reason: Bradycardia is not typical in hypovolemic shock. The body responds to low blood volume with tachycardia to maintain cardiac output and tissue perfusion. Bradycardia may occur in late, decompensated shock due to severe hypoxia or myocardial depression, but it is not an expected finding in earlier stages, where sympathetic activation predominates.

Choice D reason: Increased urine output is not expected in hypovolemic shock. The kidneys respond to reduced blood volume by decreasing urine production through activation of the renin-angiotensin-aldosterone system, which promotes sodium and water retention. Oliguria (low urine output) is typical, as the body conserves fluid to restore intravascular volume and maintain blood pressure.

Choice A reason: Nuchal rigidity, or neck stiffness, is a hallmark of bacterial meningitis due to meningeal inflammation irritating the spinal nerves and muscles. This causes resistance to neck flexion, often accompanied by fever, headache, and photophobia. It reflects the inflammatory response to bacterial invasion of the meninges, a critical diagnostic sign.

Choice B reason: Hypoactive deep tendon reflexes are not typical in bacterial meningitis. The condition causes central nervous system irritation, often leading to hyperactive reflexes due to meningeal inflammation. Hypoactive reflexes may occur in peripheral neuropathies or late-stage neurological diseases, not in acute meningitis, where irritability and hyperreflexia are more common.

Choice C reason: Bradycardia is not expected in bacterial meningitis. The systemic inflammatory response and fever typically cause tachycardia as the body compensates for infection and increased metabolic demand. Bradycardia may occur in late stages with increased intracranial pressure, but it is not a primary or early finding in meningitis.

Choice D reason: Increased appetite is not associated with bacterial meningitis. The condition causes systemic symptoms like fever, headache, and nausea, often leading to anorexia due to inflammation and discomfort. Increased metabolic demand exists, but patients typically experience reduced appetite, making this an unlikely finding in acute bacterial meningitis.