# A client with diabetic ketoacidosis has blood glucose 520 mg/dL, dry mucous membranes, and blood pressure 88/54 mm Hg. Which prescription should the nurse implement first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397145&lang=en  
> language: en  
> subject: Illness Management  
> category: PA

## Question

A client with diabetic ketoacidosis has blood glucose 520 mg/dL, dry mucous membranes, and blood pressure 88/54 mm Hg. Which prescription should the nurse implement first?

## Option

1. Start the prescribed isotonic IV fluid bolus. **✔ Correct answer**
2. Administer subcutaneous long-acting insulin.
3. Give sodium bicarbonate for all clients with ketoacidosis.
4. Restrict fluids until serum sodium is normal.

**Correct answer: 1**

## Explanation

Initial management of diabetic ketoacidosis with hypotension focuses on restoring circulating volume with isotonic fluids. Insulin is important but severe volume depletion and perfusion must be addressed promptly. Sodium bicarbonate is not routine for all clients, and fluid restriction worsens hypovolemia.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits DKA with hypovolemia.

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 DKA with hypovolemia, 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 osmolality similar to plasma, used to restore volume.
- **Hypovolemia** — Reduced circulating blood volume that can impair perfusion.

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