A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider?

Choice A rationale Oral hypoglycemic medications are used for the long-term management of Type 2 diabetes and are entirely inappropriate for an acute, life-threatening emergency like diabetic ketoacidosis. In DKA, the patient has an absolute or relative insulin deficiency and severe metabolic derangements. The gastrointestinal tract is often slowed due to the crisis, and oral medications cannot work fast enough or provide the intensive insulin therapy required to stop ketone production and lower a glucose level of 925 mg/dL. Choice B rationale Dextrose-containing fluids like D5 are eventually used in the treatment of DKA, but only after the blood glucose has dropped to a safer level, usually around 250 mg/dL. Giving dextrose when the patient's blood glucose is currently 925 mg/dL would be extremely dangerous and would further increase serum osmolality. The initial goal of therapy is to dilute the high sugar concentration and restore volume, not to add more glucose to an already severely hyperglycemic state. Choice C rationale Glucocorticoids are steroid medications that actually increase blood glucose levels by stimulating gluconeogenesis and antagonizing the effects of insulin. Administering glucocorticoids to a patient in DKA with a blood glucose of 925 mg/dL would exacerbate the hyperglycemia and metabolic acidosis. These medications are contraindicated in the acute management of hyperglycemic crises because they counteract the primary goal of lowering the blood sugar and stabilizing the patient's metabolic state through insulin administration. Choice D rationale The first priority in managing diabetic ketoacidosis is aggressive fluid resuscitation to restore circulatory volume and improve renal perfusion. A blood glucose of 925 mg/dL causes profound osmotic diuresis, leading to severe dehydration. 0.9.