A nurse is caring for a client with diabetic ketoacidosis (DKA). Which of the following interventions is the priority?

Choice A reason: Administering insulin infusion is the priority in DKA to correct hyperglycemia and halt ketogenesis. Insulin lowers blood glucose by facilitating cellular uptake and inhibits lipolysis, reducing ketone production. This addresses the underlying metabolic derangement, preventing further acidosis and stabilizing the patient’s condition rapidly, critical for life-threatening DKA. Choice B reason: Providing oral glucose is contraindicated in DKA, as the client already has severe hyperglycemia. Adding glucose would worsen the condition, increasing osmotic diuresis and acidosis. The focus is on lowering blood sugar with insulin and fluids, not adding more glucose, which could exacerbate dehydration and metabolic imbalance. Choice C reason: Sodium bicarbonate may be used in severe DKA with profound acidosis (pH < 7.0), but it is not the priority. Insulin and fluid resuscitation correct the underlying cause of acidosis by stopping ketone production and restoring perfusion. Bicarbonate is an adjunct and may cause complications like hypokalemia if used prematurely. Choice D reason: Deep breathing exercises do not address the metabolic cause of DKA. While compensatory hyperventilation (Kussmaul respirations) occurs to correct acidosis, encouraging breathing exercises does not treat hyperglycemia or ketosis. Insulin and fluids are critical to reverse the underlying pathology, making breathing exercises a low-priority intervention in this acute condition.