A nurse is caring for a client in the emergency department. Complete the following sentence by using the lists of options. The nurse should plan to first administer dropdownfollowed bydropdown

Rationale for Correct Choices: 0.9% Sodium chloride: This is the correct first intervention. The client is hypovolemic, as indicated by hypotension, tachycardia, skin tenting, and elevated BUN/creatinine. Rapid isotonic fluid replacement with 0.9% sodium chloride is the priority in DKA because restoring intravascular volume improves perfusion, prevents shock, and helps lower blood glucose. Fluids are administered before insulin to reduce the risk of worsening hypotension and hypoperfusion. Regular insulin: Insulin therapy is essential to lower blood glucose, halt ketone production, and correct metabolic acidosis. However, insulin is only started after initial fluid resuscitation and once potassium levels are safely above 3.3 mEq/L to prevent severe hypokalemia. Administering insulin first, before adequate fluid resuscitation, could worsen hypovolemia and precipitate shock. Rationale for Incorrect Choices: Potassium chloride: This is not administered first because the client’s potassium is currently elevated at 5.5 mEq/L. Potassium replacement is delayed until levels fall below 5.0 mEq/L during insulin therapy to avoid hyperkalemia-related cardiac arrhythmias. Ondansetron: This is used as needed for nausea but is not a priority over fluid resuscitation or insulin in DKA management. Magnesium sulfate: Magnesium replacement is not the immediate priority; it is administered only if hypomagnesemia is confirmed. The client’s magnesium level is not provided, and it is secondary to fluid and insulin therapy.