The nurse is caring for a client with diabetic ketoacidosis (DKA). Which intervention is most important?

Questions 69

HESI RN

HESI RN Test Bank

HESI RN Exit Exam 2024 Quizlet Questions

Question 1 of 5

The nurse is caring for a client with diabetic ketoacidosis (DKA). Which intervention is most important?

Correct Answer: A

Rationale: Administering insulin is the most crucial intervention in managing diabetic ketoacidosis. Insulin helps reduce blood glucose levels and correct metabolic acidosis, which are the primary issues in DKA. Monitoring urine output (Choice B) is important but not as critical as administering insulin. Assessing the client's level of consciousness (Choice C) is essential but does not directly address the underlying cause of DKA. Obtaining an arterial blood gas sample (Choice D) can provide valuable information but is not as urgent as administering insulin to address the immediate metabolic imbalance.

Question 2 of 5

A client with chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. Which intervention should the nurse implement first?

Correct Answer: A

Rationale: In a client with COPD admitted with pneumonia, the priority intervention should be to administer oxygen therapy as prescribed. This is crucial to improve oxygenation, especially in a client with compromised respiratory function. Elevating the head of the bed can help with breathing but is secondary to ensuring adequate oxygenation. Obtaining a sputum culture and administering antibiotics are important steps in the treatment of pneumonia but come after ensuring adequate oxygen supply.

Question 3 of 5

The nurse is caring for a client with chronic kidney disease (CKD). Which laboratory value should be reported to the healthcare provider immediately?

Correct Answer: C

Rationale: The correct answer is C. A potassium level of 6.5 mEq/L is dangerously high, a condition known as hyperkalemia, and requires immediate intervention to prevent cardiac complications. Hyperkalemia can lead to life-threatening arrhythmias, making it crucial to notify the healthcare provider promptly. Choices A, B, and D do not indicate immediate life-threatening conditions. Elevated serum creatinine levels are expected in CKD, a hemoglobin level of 10 g/dl is within a reasonable range, and a blood glucose level of 150 mg/dl is not acutely concerning in this context.

Question 4 of 5

A client with diabetes mellitus is admitted with a blood glucose level of 600 mg/dl and is unresponsive. Which intervention should the nurse implement first?

Correct Answer: B

Rationale: Administering IV fluids as prescribed should be the first intervention for a client with diabetes mellitus admitted with a blood glucose level of 600 mg/dl and unresponsive. This intervention is crucial in managing hyperglycemia by helping to correct dehydration and electrolyte imbalances. Administering 50% dextrose IV push (Choice A) would worsen hyperglycemia in this scenario. Checking the client's blood glucose level (Choice C) is important but not the priority when dealing with an unresponsive client with severe hyperglycemia. Immediate dialysis preparation (Choice D) is not indicated as the first intervention for hyperglycemia.

Question 5 of 5

A client with a history of chronic kidney disease is scheduled for a renal biopsy. Which laboratory value should the nurse report to the healthcare provider before the procedure?

Correct Answer: D

Rationale: A platelet count of 90,000/mm3 is low and concerning for a client scheduled for a renal biopsy, as it increases the risk of bleeding. Thrombocytopenia, indicated by a low platelet count, can lead to impaired blood clotting, posing a significant risk of bleeding during or after the biopsy procedure. Elevated serum creatinine levels may be expected in chronic kidney disease but are not directly related to bleeding risk during a renal biopsy. Prothrombin time and hemoglobin levels are not as directly relevant to the bleeding risk associated with a renal biopsy as platelet count.

Access More Questions!

HESI RN Basic


$89/ 30 days

HESI RN Premium


$150/ 90 days

Similar Questions