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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C)"Displayamonthlycalendarintheclient'sroom.":Amonthlycalendarmightbetoocomplexandoverwhelming.SimplercueslikedailyschedulesaremoreeffectiveforsomeonewithAlzheimer'sdisease.
D)"Providetheclientwithstructuredactivitiestofilltheirtime.":Structuredactivitiescanhelpmaintaintheclient'scognitivefunctionsandprovideasenseofroutine,whichisessentialforreducinganxietyandpromotingasenseofnormalcy.
Correct Answer is B
Explanation
A) Epinephrine: Epinephrine is primarily used in emergencies for conditions such as anaphylaxis or cardiac arrest. It would not be indicated for managing thirst or urinary output
in this context.
B) Desmopressin: This medication is a synthetic vasopressin analog used to treat diabetes insipidus, which can result from brain injuries affecting the hypothalamus or pituitary gland. Given the client's significant urinary output of 4,000 mL, which suggests possible diabetes insipidus, desmopressin is the most appropriate medication to address the excessive urination and thirst.
C) Nitroprusside: Nitroprusside is a potent vasodilator used to manage acute hypertension. It is not relevant to the symptoms described and would not help in managing thirst or urinary output issues.
D) Furosemide: Furosemide is a diuretic that would increase urinary output rather than decrease it. Since the client is already experiencing high urinary output, furosemide would not be appropriate.