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 ["A","B","C"]
Explanation
A) Chronic infections of the middle ear: Chronic middle ear infections can lead to damage of the structures within the ear, resulting in conductive hearing loss. This is a significant risk factor for hearing loss, particularly in children and young adults.
B) Use of a loop diuretic: Loop diuretics, such as furosemide, can be ototoxic, especially at high doses or when used in conjunction with other ototoxic medications. This can result in hearing loss, making this a relevant risk factor to discuss.
C) Perforation of the eardrum: A perforated eardrum can lead to conductive hearing loss and increase the risk of infections, which may further compromise hearing. It is essential to include this in the discussion of risk factors for hearing loss.
D) Born with a high birth weight: High birth weight alone is not a recognized risk factor for hearing loss. While certain conditions associated with high birth weight may impact hearing, it is not a direct factor.
E) Frequent exposure to low-volume noise: Low-volume noise exposure is typically not a risk factor for hearing loss. It is the exposure to loud noise over time that poses a greater risk. Therefore, this factor should not be included in the teaching.
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.