A nurse is providing interventions for a client with panic disorder.
Which interventions should the nurse include in the plan of care? (Select all that apply).

Choice A rationale:

The client being the oldest of their siblings is not a contributing factor related to the development of conduct disorder. Family dynamics such as birth order may have some influence on personality traits, but they are not a primary factor in the development of conduct disorder.

Choice B rationale:

The fact that the client's father lives in the client's home is a family dynamic, but it does not necessarily contribute to the development of conduct disorder. Other factors related to parenting style, communication, and family interactions play a more significant role in the development of conduct disorder.

Choice C rationale:

The client's mother having asthma is a medical condition and not a family dynamic that directly contributes to the development of conduct disorder. Conduct disorder is more closely associated with social, environmental, and psychological factors.

Choice D rationale:

The presence of several siblings in the family dynamic can contribute to the development of conduct disorder. Increased family size can lead to competition for attention and resources, which may affect the child's behavior and interactions. Sibling relationships and family dynamics are crucial in shaping a child's behavior and psychological well-being.

Choice A rationale:

Starting an insulin drip at 0.1 u/kg/hr is a common treatment for diabetic ketoacidosis (DKA). The goal is to lower blood glucose levels while avoiding a rapid decrease that could lead to cerebral edema. Insulin infusions allow for precise control of the rate and can be adjusted as needed based on the patient’s response.

Choice B rationale:

Giving a long-acting insulin dose is not typically done during the acute treatment of DKA. The patient has already taken a dose of insulin glargine at home. Additional doses of long-acting insulin could potentially lead to hypoglycemia.

Choice C rationale:

Providing an oral medication that enhances insulin production would not be beneficial in this case. The patient has type 1 diabetes, which means her body does not produce insulin. Therefore, medications that stimulate insulin production would not be effective.

Choice D rationale:

Changing the intravenous fluid to 5% dextrose and 0.45% sodium chloride with 20 mEq potassium can help prevent hypoglycemia and hypokalemia, which are potential complications of DKA treatment. As blood glucose levels decrease with treatment, dextrose can help maintain appropriate glucose levels. Potassium is often depleted in DKA and needs to be replaced.

Choice E rationale:

Having the client drink as much as they can tolerate would not be appropriate at this time. The patient is currently experiencing nausea and vomiting, which could be exacerbated by oral fluid intake. Additionally, she is NPO (nothing by mouth), likely due to her unstable condition.

Choice F rationale:

Giving 1 L of 0.9% sodium chloride IV can help correct dehydration, which is common in DKA due to excessive urination caused by high blood glucose levels.

Choice G rationale:

Promoting removal of electrolytes with a diuretic would not be beneficial in this case. The patient is likely already dehydrated and may have electrolyte imbalances due to DKA. Using a diuretic could exacerbate these issues.

Choice H rationale:

Giving a multivitamin is not typically part of the acute treatment for DKA. While overall nutritional status is important in managing diabetes, it would not address the immediate concerns of hyperglycemia and acidosis in DKA.

Choice I rationale:

Replacing potassium as needed is crucial in the treatment of DKA. Potassium levels can drop rapidly during treatment as insulin allows potassium to move back into cells. Low potassium (hypokalemia) can cause dangerous heart rhythms and muscle weakness.