Exhibits A nurse is initiating a plan of care for a client who has diabetes mellitus. Which of the following interventions should the nurse include? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Nursing care for a client with diabetic ketoacidosis (DKA) focuses on correcting hyperglycemia, resolving metabolic acidosis, and restoring metabolic stability. DKA is characterized by insulin deficiency leading to uncontrolled glucose production, ketone formation, dehydration, and electrolyte disturbances such as hyperkalemia. The presence of hyperglycemia (350 mg/dL), positive urine ketones, metabolic acidosis (low HCO₃⁻), and tachypnea confirms an acute metabolic emergency requiring immediate insulin therapy. Diabetic ketoacidosis Rationale: A. Administering glucagon IV is inappropriate because glucagon is used to treat severe hypoglycemia, not hyperglycemia or ketoacidosis. In this client, blood glucose is significantly elevated, so glucagon would worsen hyperglycemia by further stimulating hepatic glucose release. This intervention is contraindicated in the current clinical condition. B. Giving the client graham crackers is inappropriate because oral carbohydrate intake is used for hypoglycemia management, not hyperglycemia or DKA. The client’s blood glucose is markedly elevated at 350 mg/dL, and administering carbohydrates would further increase serum glucose levels. Additionally, the client may have altered metabolism and cannot safely process additional carbohydrates. C. Restricting fluid intake is incorrect because clients with DKA are typically severely dehydrated due to osmotic diuresis from hyperglycemia. Fluid replacement is a critical early intervention to restore circulating volume and improve renal perfusion. Restricting fluids would worsen dehydration, impair perfusion, and delay metabolic recovery. D. Administering a continuous IV infusion of insulin is the priority intervention because it directly addresses the underlying cause of DKA by reducing blood glucose and stopping ketone production. Regular insulin infusion allows controlled correction of hyperglycemia and metabolic acidosis while enabling careful monitoring of potassium shifts. This is the definitive treatment for resolving DKA and stabilizing the client.