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

A. Regular insulin 20 units subcutaneously: Acute DKA management requires intravenous insulin, not subcutaneous dosing. IV insulin allows rapid onset, precise titration, and consistent absorption, which are essential for correcting hyperglycemia and acidosis safely. B. Insert indwelling urinary catheter: Although monitoring intake and output is important in DKA, an indwelling catheter is not routinely indicated unless the client is critically unstable, unable to void, or requires strict hourly urine output measurement. This client is alert and oriented and can likely void independently. C. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L: The client’s potassium is currently elevated at 5.5 mEq/L. Potassium replacement is withheld initially in DKA until levels begin to decrease. Administering potassium now would increase the risk of cardiac dysrhythmias. D. Dextrose 5% in water (D5W) intravenous at 5 mL/kg/hr for 4 hr: Dextrose-containing fluids are added later in treatment, once the blood glucose decreases to approximately 200–250 mg/dL, to prevent hypoglycemia while continuing insulin therapy. This client’s glucose remains critically high. E. 0.9% sodium chloride at 15 mL/kg/hr for 1 hr and then reduce to 10 mL/kg/hr: The priority in DKA is rapid isotonic fluid resuscitation to correct dehydration, improve blood pressure, enhance renal perfusion, and lower glucose through dilution. The client shows signs of hypovolemia, including hypotension, tachycardia, and skin tenting. F. Blood glucose checks every 4 hr: In DKA, blood glucose must be monitored at least hourly to guide insulin titration and prevent rapid glucose shifts that could lead to complications such as cerebral edema or hypoglycemia. G. Initiate cardiac monitoring: The client has hyperkalemia and is at risk for rapid potassium shifts once insulin therapy begins. Continuous cardiac monitoring is necessary to detect potentially life-threatening arrhythmias. H. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L: Continuous IV insulin infusion is the standard of care for DKA. Insulin therapy is initiated only when potassium is above 3.3 mEq/L to avoid precipitating severe hypokalemia as potassium shifts back into cells.