A nurse is caring for a client who is experiencing diabetic ketoacidosis (DKA). Which of the following is the priority intervention by the nurse?

Nursing management of Diabetic ketoacidosis focuses on restoring circulating volume, correcting electrolyte imbalances, and gradually reversing hyperglycemia. DKA is characterized by severe insulin deficiency, hyperglycemia, ketone production, and metabolic acidosis, leading to dehydration and hypovolemia due to osmotic diuresis. The priority in early management is stabilizing circulation and perfusion before insulin therapy is fully effective. Fluid resuscitation is essential to restore intravascular volume and improve organ perfusion. Rationale: A. Beginning bicarbonate continuous IV infusion is not a priority and is generally reserved for severe acidosis (pH < 6.9). Routine use of bicarbonate in DKA is controversial because it can worsen hypokalemia and delay ketone clearance. The main treatment priorities are fluids and insulin rather than direct correction of acidosis with bicarbonate. B. Administering 0.9% sodium chloride is the priority intervention because it rapidly restores intravascular volume depleted by osmotic diuresis. Fluid resuscitation improves tissue perfusion, enhances renal clearance of glucose and ketones, and helps stabilize blood pressure. Without initial fluid replacement, other interventions such as insulin therapy may be less effective and potentially unsafe. C. Checking potassium levels is an essential assessment but not the immediate priority intervention. Potassium in DKA can be misleading because serum levels may initially appear normal or elevated despite total body potassium depletion. However, correction of fluid volume and circulation takes precedence before full electrolyte management decisions are made. D. Initiating a continuous IV insulin infusion is a critical component of DKA management but should follow initial fluid resuscitation. Starting insulin without correcting hypovolemia can cause rapid shifts in glucose and potassium, increasing the risk of complications such as cerebral edema or hypokalemia. Fluids are prioritized first to stabilize circulation before insulin administration.