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 dropdown followed by dropdown.

Rationale for correct choices • 0.9% sodium chloride: Fluid resuscitation is the priority in a client with hyperglycemia, dehydration, and early diabetic ketoacidosis (DKA). The client shows signs of hypovolemia, including hypotension, tachycardia, and tenting of the skin. Administering isotonic saline restores intravascular volume, improves renal perfusion, and helps dilute blood glucose. • Insulin: Once fluid resuscitation is initiated and potassium levels are adequate (>3.3 mEq/L), insulin therapy can safely begin to reduce hyperglycemia and ketone production. Insulin shifts glucose and potassium into cells, correcting metabolic derangements. Administering insulin before fluids or potassium correction could worsen hypovolemia or precipitate hypokalemia. Rationale for incorrect choices • Magnesium supplementation: Although magnesium may be necessary if the client is hypomagnesemic, it is not immediately life-threatening in this scenario. Correcting fluid deficit and hyperglycemia takes precedence to stabilize perfusion and metabolic status. Magnesium supplementation can follow initial DKA management. • Acetaminophen: The client does not currently exhibit fever or pain requiring urgent intervention. Pain or fever management does not take priority over fluid and insulin therapy in hyperglycemic crises. Administering acetaminophen first would delay life-saving treatment. • Ondansetron: Ondansetron can help control nausea, but it does not address the primary life-threatening problems of dehydration and hyperglycemia. Anti-emetic therapy is supportive and secondary to restoring perfusion and initiating insulin therapy. Administering ondansetron first could delay critical DKA treatment. • Potassium: Potassium is essential for safe insulin therapy, but the client’s potassium is 5.5 mEq/L, which is above the threshold requiring supplementation. Potassium will only be administered PRN if it drops below 5.0 mEq/L. Therefore, it is not the first priority at this time.