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) Generalized abdominal pain: While abdominal pain can occur with peritonitis, it is not always the earliest indication. Pain may develop after other symptoms become apparent, making it less specific as an initial sign.
B) Fever: Fever is a common symptom of infection, including peritonitis. However, it can also occur in various other conditions and may not be the first noticeable symptom, especially if the infection is localized.
C) Cloudy effluent: Cloudy or turbid dialysate effluent is often the earliest and most specific indication of peritonitis in patients undergoing peritoneal dialysis. This change in the appearance of the effluent suggests an infection, and the presence of cloudy fluid should prompt further evaluation for peritonitis.
D) Increased heart rate: An increased heart rate can be a response to various conditions, including infection, but it is not specific to peritonitis and may not be the earliest sign.
Correct Answer is A
Explanation
A) Negative sputum cultures for acid-fast bacillus: This is the primary indicator that a client with pulmonary tuberculosis is no longer infectious. Once the sputum cultures are negative for acid-fast bacilli on two consecutive tests, the client is considered to have a reduced risk of transmitting the infection to others.
B) Mantoux skin test revealing an induration of less than 1 mm: A negative Mantoux test (induration of less than 5 mm) indicates that the person has not been exposed to TB or does not have an active infection. However, this test is not used to determine infectiousness and may not be relevant for someone already diagnosed with TB.
C) Client no longer coughing up blood-tinged sputum: While the absence of blood-tinged sputum may indicate improvement, it does not necessarily mean the client is no longer infectious. Infectiousness is more accurately assessed through sputum cultures.
D) Positive Quantiferon-TB Gold test (negative): The Quantiferon-TB Gold test is a blood test that can indicate TB infection but does not determine whether the client is infectious. A positive result can occur even when a client is being effectively treated for tuberculosis.