A nurse is preparing to infuse dextrose 5% in 0.45% sodium chloride 500 mL IV bolus over 4 hr. The drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the IV infusion to deliver how many gtt/min? (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. Pursue local protective services: While protective services can be considered if there are signs of abuse or neglect, this is not the immediate recommendation in this situation. The caregiver's fatigue and irritability indicate stress, not abuse, other support options should be explored first.

B. Consider respite care services: Respite care provides temporary relief for caregivers, allowing them to rest and recharge. This is the most appropriate recommendation for a caregiver experiencing stress, as it helps prevent burnout and promotes better care for the client.

C. Take a nonprescription sleeping medication: While the caregiver may need better rest, self-medicating with nonprescription sleeping medication is not the best approach. It is more important to address the underlying cause of the caregiver’s stress and fatigue through proper support and respite services.

D. Contact hospice services for end-of-life care: Hospice services are for end-of-life care, typically for clients in the final stages of a terminal illness. Alzheimer's disease may lead to progressive decline, but this recommendation is premature.