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) Diuretic: Diuretics are not typically indicated following an ischemic stroke unless there are specific comorbid conditions, such as heart failure or hypertension, that warrant their use. They do not address the primary needs of stroke management.
B) Anticonvulsant: While some stroke patients may require anticonvulsants if they experience seizures, this is not a standard therapy for all ischemic stroke patients upon discharge. The primary focus after an ischemic stroke is often on preventing future strokes rather than seizure control.
C) Opioid analgesic: Opioids are generally not indicated for stroke management and are not a standard part of discharge therapy. Pain management is important, but other medications are prioritized for stroke prevention and rehabilitation.
D) Antithrombotic: Antithrombotic therapy, which includes antiplatelet agents (like aspirin) or anticoagulants, is crucial for preventing further ischemic events. This type of pharmacologic therapy is typically prescribed for patients post-ischemic stroke to reduce the risk of subsequent strokes.
Correct Answer is B
Explanation
A) Fever: While fever can occur in various allergic reactions, it is not a specific indicator of anaphylaxis. It may signal an infection or other inflammatory process rather than an immediate hypersensitivity reaction.
B) Laryngeal edema: This is a hallmark sign of anaphylaxis. It indicates swelling in the throat that can compromise the airway, making it a critical and life-threatening response. Immediate recognition and intervention are necessary to ensure the client's airway remains patent.
C) Hypertension: Although anaphylaxis can sometimes lead to hypotension due to vascular collapse, hypertension is not typically a sign of anaphylaxis. Instead, hypotension is more commonly associated with severe allergic reactions.
D) Arrhythmia: While arrhythmias can occur due to various causes, including stress or electrolyte imbalances, they are not a direct indicator of anaphylaxis. Anaphylaxis primarily presents with respiratory symptoms, skin reactions, and gastrointestinal symptoms, rather than primarily affecting heart rhythm.