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 C
Explanation
A) A client who has diabetes mellitus and is presenting with acute ketoacidosis: While this client requires careful monitoring and may need a private room if they are at risk for complications, they generally do not require isolation from other clients.
B) A client who has a compound fracture of the right femur: This client does not require a private room. Although they may need specific positioning and care, there are typically no infectious or isolation concerns.
C) A client who reports having fever, right sweats, and cough for 2 days: This client requires a private room due to the possibility of an infectious condition, such as pneumonia or tuberculosis. Symptoms like fever and cough, along with sweating, raise concerns about contagious diseases, making isolation necessary to protect other clients.
D) An older adult client who was admitted with aspiration pneumonia: While this client may need close monitoring, they do not automatically require a private room unless there are additional infection control concerns or if they are particularly contagious.
Correct Answer is D
Explanation
A) Heart rate 60/min: A heart rate of 60 beats per minute is on the lower end of the normal range. While bradycardia can be concerning, it does not indicate the need for an increase in dopamine dosage specifically. The primary goal of dopamine administration in hypovolemic shock is to improve perfusion and blood pressure, rather than solely addressing heart rate.
B) Respiratory rate 14/min: A respiratory rate of 14 breaths per minute is within the normal range for adults. This finding suggests that the client is not experiencing respiratory distress and does not warrant an increase in the dopamine dosage. The focus should be on hemodynamic parameters rather than respiratory rate in this context.
C) Oxygen saturation 95%: An oxygen saturation of 95% is considered acceptable and indicates adequate oxygenation. While maintaining oxygen saturation is important, this finding does not directly reflect the effectiveness of dopamine in improving hemodynamics. Therefore, it does not indicate the need for a dosage increase.
D) Blood pressure 90/50 mm Hg: A blood pressure reading of 90/50 mm Hg indicates hypotension and poor perfusion, which is a significant concern in a client with hypovolemic shock. An increase in dopamine dosage is warranted in this situation, as dopamine is administered to enhance cardiac output and improve blood pressure. Therefore, this finding strongly indicates the need to adjust the medication to ensure adequate hemodynamic support.