# A client with diabetic ketoacidosis has dry mucous membranes, heart rate 122/min, blood pressure 88/54 mm Hg, and glucose 560 mg/dL. Which prescription should the nurse implement first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396592&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with diabetic ketoacidosis has dry mucous membranes, heart rate 122/min, blood pressure 88/54 mm Hg, and glucose 560 mg/dL. Which prescription should the nurse implement first?

## Option

1. Give subcutaneous long-acting insulin and discharge the client.
2. Restrict fluids until the blood glucose is below 200 mg/dL.
3. Begin isotonic IV fluid resuscitation as prescribed. **✔ Correct answer**
4. Administer potassium only after urine output stops.

**Correct answer: 3**

## Explanation

DKA commonly causes severe dehydration and hypoperfusion, so isotonic IV fluids are an early priority before or along with insulin therapy according to protocol. Fluid restriction worsens shock risk. Potassium management requires close monitoring, not waiting for no urine output.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits Diabetic ketoacidosis dehydration.

Memory Tip
Match the strongest cue cluster to the safest nursing judgment.

KR vs US
NCLEX items reward cue-based priority thinking rather than isolated recall.

## Clinical scenario

Clinical Practice Guide
For Diabetic ketoacidosis dehydration, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **Diabetic Ketoacidosis** — A hyperglycemic emergency with ketosis, acidosis, and dehydration.
- **Isotonic Fluid** — IV fluid with similar osmolarity to plasma, used for intravascular volume support.
- **Hypoperfusion** — Inadequate blood flow to tissues.

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