A nurse is caring for a client in the emergency department. Complete the following sentence by using the lists of options. The nurse should administer a total of dropdown0.9% sodium chloride in the first hour, and then dropdowneach subsequent hour.

Rationale for Correct Choices • 1 L of 0.9% sodium chloride in the first hour: In diabetic ketoacidosis (DKA), the initial priority is rapid fluid resuscitation to restore intravascular volume and improve tissue perfusion. Administering 1 L of isotonic saline during the first hour helps correct hypotension, tachycardia, and dehydration caused by osmotic diuresis. This bolus stabilizes the client and prepares for subsequent insulin therapy. • 500 mL each subsequent hour: After the initial fluid bolus, continuing isotonic saline at a slower rate (typically 500 mL per hour) maintains hydration, supports renal perfusion, and gradually corrects electrolyte imbalances. This stepwise approach prevents fluid overload while addressing ongoing losses from polyuria and vomiting. Rationale for Incorrect Choices • 2 L in the first hour: Administering 2 L rapidly can cause fluid overload, pulmonary edema, or worsening cardiac strain, especially in clients with potential comorbidities such as hypertension or cardiac dysfunction. A controlled initial bolus of 1 L is safer and evidence-based. • 500 mL in the first hour: Starting with only 500 mL is insufficient for correcting significant hypovolemia in DKA. Rapid intravascular volume replacement is necessary to prevent shock and improve perfusion. • 100 mL each subsequent hour: A rate of 100 mL/hr is too slow to meet ongoing fluid needs in a dehydrated client with DKA. Inadequate fluid replacement prolongs hypovolemia, delays renal recovery, and worsens electrolyte imbalances. • 1 L each subsequent hour: Maintaining a rate of 1 L/hr after the initial bolus may lead to fluid overload, especially in older adults or those with cardiac or renal compromise. A slower maintenance rate of 500 mL/hr balances hydration with safety.