A client with diabetes presents with severe thirst, urinating copiously, and extreme fatigue. What is the nurse's priority action?

• A. Start an IV and begin fluid replacement with 0.9% NaCl
• B. Administer oral glucose
• C. Notify the healthcare provider
• D. Perform a glucose tolerance test

Answer: (A)

The priority action in this scenario is to start an IV and begin fluid replacement with 0.9% NaCl. The symptoms of severe thirst, copious urination, and extreme fatigue indicate a possible hyperglycemic state, which can lead to dehydration and electrolyte imbalances. Administering intravenous fluids helps to quickly restore hydration, dilute excess glucose in the bloodstream, and prevent potential complications such as diabetic ketoacidosis or hyperglycemic hyperosmolar state.

Initiating fluid therapy with isotonic saline (0.9% NaCl) is especially important because it addresses both the dehydration caused by polyuria and the need to stabilize the patient's condition. This action can also help improve blood pressure and perfusion to vital organs.

While notifying the healthcare provider and the administration of oral glucose might be necessary steps in managing a diabetic patient, in the context of this particular presentation of symptoms, immediate fluid resuscitation takes precedence to prevent further deterioration. A glucose tolerance test is not appropriate in this acute setting, as it does not provide immediate information regarding the patient's current state or allow for timely intervention.