A nurse is caring for a patient who has diabetic ketoacidosis (DKA) and hypoxia. Which of the following actions should the nurse take first?
Obtain a prescription for supplemental oxygen.
Obtain a prescription to administer intravenous fluids.
Obtain a prescription to administer insulin.
Obtain a prescription to check the patient's glucose level.
The Correct Answer is A
A. Obtain a prescription for supplemental oxygen. – Correct Answer. Hypoxia must be corrected first to prevent tissue hypoxia and organ failure.
B. Obtain a prescription to administer intravenous fluids. – Incorrect. IV fluids are important but oxygenation is the priority.
C. Obtain a prescription to administer insulin. – Incorrect. Insulin corrects hyperglycemia but is not the first priority over oxygenation.
D. Obtain a prescription to check the patient’s glucose level. – Incorrect. While glucose monitoring is essential, treating hypoxia takes priority.
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Related Questions
Correct Answer is C
Explanation
A. Clarify the prescription because the insulin should not be administered at this time. – Incorrect. Aspart insulin is rapid-acting and should be given with meals to prevent post-meal hyperglycemia.
B. Hold breakfast for one hour after the insulin administration. – Incorrect. Rapid-acting insulin peaks quickly (within 30-90 minutes), so delaying food increases the risk of hypoglycemia.
C. Administer insulin when breakfast arrives. – Correct Answer. Aspart insulin should be given right before or with food to match glucose absorption and prevent hypoglycemia.
D. Check the blood glucose immediately after breakfast. – Incorrect. Blood glucose should be checked before insulin administration to ensure appropriate dosing.
Correct Answer is D
Explanation
A. High fever. – Incorrect. Fever can occur with infection but is not a hallmark sign of sickle cell crisis.
B. Constipation. – Incorrect. Constipation is not a defining symptom of sickle cell crisis.
C. Bradycardia. – Incorrect. Tachycardia, not bradycardia, is common due to pain and hypoxia.
D. Pain. – Correct Answer. Severe pain is the most common symptom of sickle cell crisis due to vaso-occlusion and ischemia.
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