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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Correct Answer is D
Explanation
A) "It is normal to feel this way after a morning run.": While some fatigue can be expected after exercise, the client's symptoms of diaphoresis, palpitations, and exhaustion suggest that there may be an underlying issue related to their diabetes management, such as hypoglycemia. This response downplays the seriousness of their symptoms.
B) "It becomes easier when exercise is a routine.": While it is true that regular exercise can improve fitness and make physical activity feel easier over time, this response does not address the immediate concern of the client's current symptoms, which could indicate hypoglycemia.
C) "Were you careful to not have carbohydrates after the run?": This response suggests a misunderstanding of the client's needs. After exercise, especially for someone with type 1 diabetes, it is important to ensure adequate carbohydrate intake to prevent hypoglycemia. The client may need carbohydrates rather than avoiding them.
D) "Did you decrease your insulin intake before you exercised?": This is the most appropriate response. Clients with type 1 diabetes need to manage their insulin levels carefully, especially around exercise. If the client did not adjust their insulin dose or carbohydrate intake appropriately, they could be at risk for hypoglycemia, which explains their symptoms. This question encourages the client to reflect on their diabetes management in relation to their exercise.
Correct Answer is B
Explanation
A) Decorticate posturing: This is a more severe and late sign of increased intracranial pressure and indicates significant neurological impairment. It is not typically seen as an early manifestation.
B) Restlessness: Restlessness is often one of the earliest signs of increased intracranial pressure. It can indicate changes in consciousness and may be the first observable change in a client's behavior as ICP begins to rise.
C) Projectile vomiting: This is usually a later sign of increased ICP and may occur as pressure continues to increase. It suggests significant involvement of the brain and is not an early manifestation.
D) Papilledema: While papilledema (swelling of the optic nerve head) can occur with increased ICP, it often takes time to develop and is not an immediate or early sign. It typically appears after sustained elevated ICP levels.