A nurse is providing teaching to a client who has diabetes mellitus. Which of the following instructions should the nurse provide to the client to help prevent the development of nephropathy?

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. Fresh peaches: Fresh fruits, especially those with skins or high fiber content, can increase bowel motility and exacerbate diarrhea in clients with ulcerative colitis. They are not ideal choices during acute flare-ups.

B. Poached egg: Eggs are low in fiber, easy to digest, and provide high-quality protein, making them suitable for clients with ulcerative colitis who are managing diarrhea. Poached preparation avoids added fats that could irritate the gastrointestinal tract.

C. Oatmeal: Oatmeal is high in soluble fiber, which may worsen diarrhea or cause bloating in some clients with active ulcerative colitis. During acute exacerbations, low-residue foods are preferred to reduce stool frequency.

D. Whole grain toast: Whole grains contain insoluble fiber, which can increase stool bulk and aggravate diarrhea. Low-fiber, refined breads are a safer option for clients during flare-ups.