A nurse is caring for a client in the emergency department. Which of the following 3 provider prescriptions does the nurse anticipate?

Rationale: A. Insert indwelling urinary catheter: In clients with DKA who are significantly dehydrated, hypotensive, or oliguric, an indwelling catheter may be indicated to accurately monitor urine output and guide fluid replacement. This is important because fluid resuscitation and renal perfusion need close monitoring, especially with rising BUN and creatinine suggesting pre-renal azotemia. B. 0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 mEq/L: Rapid isotonic fluid replacement is the first-line therapy for DKA to correct dehydration from osmotic diuresis. The client shows signs of volume depletion, including hypotension and tented skin. Initial bolus with 0.9% sodium chloride restores intravascular volume, followed by adjusted rates based on ongoing fluid losses, hemodynamics, and renal function. C. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L: Insulin therapy in DKA drives potassium into cells, which can precipitate hypokalemia. The client’s potassium is 5.5 mEq/L, but potassium replacement is necessary once levels fall below 5.0 mEq/L to maintain cardiac and neuromuscular function. D. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L: Continuous IV insulin is required to reduce hyperglycemia, suppress ketogenesis, and correct metabolic acidosis in DKA. Initiation is delayed until potassium is above 3.3 mEq/L to avoid severe hypokalemia. Titration per DKA protocol ensures gradual glucose reduction and safe correction of electrolyte disturbances. E. Dextrose 5% in water (DSW) Intravenous at 5 ml/kg/hr for 4 hr: Dextrose is added only once blood glucose approaches 200–250 mg/dL to prevent hypoglycemia during ongoing insulin infusion. It is not indicated initially in a client presenting with severe hyperglycemia (468 mg/dL). F. Blood glucose checks every 4 hr: In DKA management, glucose monitoring must be frequent (hourly) due to rapid changes from insulin infusion. Four-hour intervals are insufficient for safe titration of IV insulin. G. Initiate cardiac monitoring: The client’s electrolyte abnormalities, particularly potassium fluctuations, and the risk of fluid shifts during DKA treatment make continuous cardiac monitoring essential. Telemetry allows early detection of arrhythmias caused by hyperkalemia initially or hypokalemia during insulin therapy H. Regular insulin 20 units subcutaneously: Subcutaneous insulin alone is inadequate for acute DKA management, which requires IV insulin infusion for controlled and rapid correction of hyperglycemia and ketosis.