# The emergency nurse reviews six presentations involving glucose dysregulation. Identify the condition best supported by each cue cluster. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=393404&lang=en > language: en > subject: Laboratory Values > category: ROR ## Question The emergency nurse reviews six presentations involving glucose dysregulation. Identify the condition best supported by each cue cluster. | | Diabetic ketoacidosis | Hyperosmolar hyperglycemic state | Hypoglycemia | | --- | --- | --- | --- | | Type 1 diabetes; abdominal pain and deep rapid respirations; glucose 286 mg/dL; beta-hydroxybutyrate 5.2 mmol/L; pH 7.20 | | | | | Taking an SGLT2 inhibitor; nausea and tachypnea; glucose 218 mg/dL; beta-hydroxybutyrate 4.1 mmol/L; bicarbonate 14 mmol/L | | | | | Type 2 diabetes; confusion and profound dehydration; glucose 842 mg/dL; effective osmolality 326 mOsm/kg; pH 7.36 | | | | | Older adult with infection; glucose 715 mg/dL; marked hyperosmolality; beta-hydroxybutyrate 1.2 mmol/L; bicarbonate 20 mmol/L | | | | | Rapid-acting insulin taken without eating; diaphoresis and tremor; glucose 54 mg/dL | | | | | Taking a sulfonylurea; new confusion and blurred vision; glucose 48 mg/dL; symptoms improve after glucose treatment | | | | ## 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. ## In-depth explanation 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 ## Clinical scenario 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. ## Key concepts - **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. ## Related questions - [A 56-year-old patient presents to the ED with BP 226/132, severe occipital headache, blurr…](https://mymerci.kr/pages/nclex_q.php?qn_id=372715&lang=en) - [A client with diabetic ketoacidosis has pH 7.28, PaCO2 26 mm Hg, and HCO3 12 mEq/L. Using …](https://mymerci.kr/pages/nclex_q.php?qn_id=393370&lang=en) - [A severely malnourished client begins tube feeding. Twenty-four hours later, phosphorus fa…](https://mymerci.kr/pages/nclex_q.php?qn_id=396144&lang=en) - [The nurse receives laboratory results for four clients. Which result requires immediate fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=497619&lang=en) - [The client has received a heparin infusion for 5 days. 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