A client with type 1 diabetes mellitus is suspected to be in diabetic ketoacidosis (DKA). What should the nurse's first action be?

In the management of a patient suspected to be in diabetic ketoacidosis (DKA), the first priority is to restore intravascular volume and improve tissue perfusion. Therefore, starting an intravenous (IV) infusion and administering a normal saline bolus is critical. This is essential for several reasons:

1. Dehydration Correction: Patients in DKA are often significantly dehydrated due to osmotic diuresis caused by high blood glucose levels. Administering a normal saline bolus helps to quickly expand the intravascular volume and address dehydration.

2. Circulatory Support: By restoring intravascular volume, the nurse can help ensure adequate blood flow to vital organs, which is particularly important given the metabolic disturbances in DKA.

3. Facilitating Insulin Treatment: Hydration is also important to prepare the body for insulin therapy. Insulin can help shift glucose back into the cells, but adequate hydration ensures that this process occurs effectively without causing further electrolyte imbalances.

While monitoring blood glucose levels and preparing for insulin therapy are essential components of DKA management, addressing hydration is the immediate need when a patient is suspected to be in DKA. Therefore, initiating the normal saline bolus takes precedence in this scenario.