The emergency nurse reviews six presentations involving glucose dysregulation. Identify the condition best supported by each cue cluster.
Matrix
Choose your responses, then check the answer.
Explanation
DKA is supported by significant ketonemia and metabolic acidosis, including euglycemic or mildly hyperglycemic presentations associated with an SGLT2 inhibitor. HHS is marked by severe hyperglycemia and hyperosmolality with little ketonemia and no major acidosis. Hypoglycemia is supported by low measured glucose with autonomic or neuroglycopenic symptoms and improvement after glucose treatment.
Correct Answer Rows 1 and 2 indicate DKA, rows 3 and 4 indicate HHS, and rows 5 and 6 indicate hypoglycemia.
Why It Fits The correct condition comes from the full pattern, not one diagnosis label or glucose value.
Clinical Picture Ketones plus acidosis point to DKA; profound hyperosmolality with minimal ketones points to HHS; low glucose plus adrenergic or brain symptoms points to hypoglycemia.
Memory Link DKA: ketones and acid. HHS: hyperosmolar dehydration. Hypoglycemia: low glucose with body or brain warning signs.
NCLEX Rule Compare the defining data cluster and avoid ruling out DKA solely because glucose is below 250 mg/dL.
Why the Alternatives Fail HHS does not fit prominent ketonemia and acidosis. DKA does not fit preserved pH with extreme osmolality and minimal ketones. Neither hyperglycemic crisis fits a measured low glucose that improves after treatment.
Sources
12024 Hyperglycemic Crises Consensus Report
22026 NCLEX-RN Test Plan
Each row describes a different adult. Use symptoms, glucose, ketones, acid-base status, and osmolality together. Mixed DKA/HHS presentations are not represented in these rows.
DKA Hallmarks — pH <7.30 with anion-gap acidosis. Glucose 250–600. Large urine and serum ketones. Kussmaul respirations, fruity breath. Volume depletion. Treatment: 0.9% NS bolus, IV insulin, K replacement once K verified.
HHS Hallmarks — Hyperosmolality >320. Glucose >600. Mild or absent ketosis. pH near normal. Severe volume depletion (often 8–12 L). Altered mental status. Treatment: 0.9% NS aggressive fluid (15–20 mL/kg in first hour), IV insulin after fluids, K replacement.
Hypoglycemia Hallmarks — Glucose <70. Neuroglycopenic symptoms (confusion, diaphoresis, tremor, slurred speech). No acidosis. No ketones. No hyperosmolality. Treatment: IV dextrose 50% for severe; rule of 15 (15 g fast-acting carb, recheck in 15 min) for alert.