A nurse is caring for a client who has diabetic ketoacidosis secondary to an infection. Which of the following prescriptions is the highest priority?
Obtain blood for culture and sensitivity.
Initiate IV infusion of regular insulin.
Initiate 0.9% sodium chloride 1,000 mL IV at 500 mL/hr.
Insert an indwelling urinary catheter.
The Correct Answer is B
A) Obtain blood for culture and sensitivity: While identifying the infection is important for treatment, it does not address the immediate metabolic crisis of diabetic ketoacidosis (DKA). This action is essential but secondary to stabilizing the client's current condition.
B) Initiate IV infusion of regular insulin: Administering insulin is critical in the management of DKA, as it helps to reduce blood glucose levels and halt the production of ketones, which are responsible for the acidosis. This intervention is vital for quickly correcting the metabolic derangement and stabilizing the patient.
C) Initiate 0.9% sodium chloride 1,000 mL IV at 500 mL/hr: While fluid replacement is important in the management of DKA to address dehydration and electrolyte imbalances, it is still not as immediately life-saving as starting insulin therapy. Fluid resuscitation typically follows the administration of insulin.
D) Insert an indwelling urinary catheter: This may be necessary for monitoring urine output and assessing kidney function, but it is not a priority intervention when addressing the acute complications of DKA. Insulin administration takes precedence in the immediate management plan.
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View Related questions
Correct Answer is A
Explanation
A) Glycosylated hemoglobin level: The glycosylated hemoglobin (HbA1c) level is the most reliable indicator of long-term glycemic control in clients with diabetes mellitus. It reflects average blood glucose levels over the past 2 to 3 months, allowing healthcare providers to assess how well the treatment plan is working over time.
B) Oral glucose tolerance test results: The oral glucose tolerance test (OGTT) is primarily used for diagnosing diabetes rather than monitoring long-term control. It assesses how well the body processes glucose but does not provide an ongoing measure of glycemic control.
C) Postprandial blood glucose level: While monitoring postprandial blood glucose (the blood glucose level after meals) is important for managing daily glucose levels, it does not give a long-term perspective on glycemic control. This measurement can fluctuate significantly based on diet and activity levels.
D) Fasting blood glucose level: The fasting blood glucose level is useful for assessing daily glucose control, but it does not provide a comprehensive view of long-term glycemic management over months like the HbA1c level does.
Correct Answer is C
Explanation
A) Administer aspirin: While administering aspirin is important in the management of acute angina to inhibit platelet aggregation, it is not the immediate priority. Aspirin helps prevent further clot formation but does not relieve the acute symptoms of angina.
B) Initiate IV access: Establishing IV access may be necessary for medication administration, but it should not be the first action taken when a client is experiencing acute angina. Immediate relief of chest pain is the priority.
C) Administer nitroglycerin: This is the first action the nurse should take. Nitroglycerin acts quickly to relieve angina by dilating coronary arteries, thus improving blood flow to the heart muscle. Relief of pain and ischemia is the immediate priority.
D) Measure blood pressure: While monitoring vital signs is crucial, especially in a client with cardiac issues, the most urgent intervention in the context of acute angina is pain relief. Blood pressure may be assessed after administering nitroglycerin since it can affect hemodynamics.