87. A client is admitted with diabetic ketoacidosis. A nurse's first priority should be to give:
Test-Taking Tip
This is a priority question. To decide between two options (fluids or bicarbonate), remember that correcting dehydration (with fluids) will improve acidosis.
Content Area: Adult Health, Endocrine; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Medication Administration
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Answer 1 is incorrect because the acidosis will correct with insulin once glucose is available to the cell so that it does not need to burn fats. Giving bicarbonate might temporarily fix pH, but it does not fix the problem of dehydration. Answer 2 is correct because clients who are admitted with high blood sugar levels are very dehydrated and need IV normal saline. High blood sugar levels dehydrate cells, spilling sugar in the kidneys and causing obligate water loss. Answer 3 is incorrect because IV albumin is an expensive and unnecessary way to correct dehydration. This client needs sodium and water. Normal saline IV is the correct action. Answer 4 is incorrect because, although the client needs insulin, it is inappropriate to give it subcutaneously. Clients who are dehydrated have poor absorption from this tissue. These clients need a continuous intravenous drip of insulin.
