What is the first step a nurse should take in the treatment of a patient presenting with diabetic ketoacidosis (DKA)?

Rationale: A. While insulin therapy is essential in DKA management to reduce hyperglycemia and stop ketone production, it is not the first step. Administering insulin before correcting fluid deficits can worsen hypotension and hypokalemia, potentially causing life-threatening complications. B. Oral glucose is used to treat hypoglycemia, not hyperglycemia or DKA. Providing glucose in DKA would be counterproductive and is inappropriate in the initial management. C. Potassium replacement is critical in DKA because insulin therapy and fluid resuscitation can shift potassium into cells, leading to hypokalemia. However, potassium administration is initiated after assessing serum levels and usually after starting IV fluids, making it secondary to fluid replacement. D. The first priority in DKA is restoring circulating volume and correcting dehydration with intravenous fluids, typically starting with isotonic saline. Fluid resuscitation helps improve tissue perfusion, correct hypotension, and enhance renal perfusion for glucose and ketone clearance. Once fluids are initiated and potassium levels are assessed, insulin therapy and electrolyte replacement follow. Early IV fluid replacement is lifesaving and addresses the most immediate threat to the patient’s stability.