An 8-year-old boy recently diagnosed with diabetes mellitus is admitted to the intensive care unit with diabetic ketoacidosis. Which nursing action has the highest priority?

• A. Place on cardiac monitor.
• B. Initiate an intravenous infusion.
• C. Collect specimen for serum electrolytes.
• D. Obtain fingerstick glucose.

Answer: (B)

Initiating intravenous fluid therapy takes priority because in diabetic ketoacidosis a child is severely dehydrated and hemodynamically unstable risk is high. Starting an IV infusion rapidly restores circulating volume, improves tissue perfusion, and creates a route to deliver insulin and electrolytes safely. Without fluids and IV access, other steps—like obtaining electrolyte labs, monitoring with a cardiac monitor, or checking a fingerstick glucose—cannot be effectively or safely carried out. After fluids are started, you can promptly obtain labs and begin appropriate insulin management, all while continuing careful monitoring.