# Drag each finding to the acute glucose emergency it most strongly supports.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

Drag each finding to the acute glucose emergency it most strongly supports.

**1.** Glucose 710 mg/dL, effective osmolality 326 mOsm/kg, beta-hydroxybutyrate 1.5 mmol/L, and pH 7.36

Select a category
DKA
HHS
Hypoglycemia

**2.** Glucose 238 mg/dL, beta-hydroxybutyrate 4.2 mmol/L, bicarbonate 14 mmol/L, and pH 7.24

Select a category
DKA
HHS
Hypoglycemia

**3.** SGLT2 inhibitor use with glucose 178 mg/dL, beta-hydroxybutyrate 4.0 mmol/L, and pH 7.25

Select a category
DKA
HHS
Hypoglycemia

**4.** Diaphoresis, tremor, and palpitations with a glucose of 54 mg/dL

Select a category
DKA
HHS
Hypoglycemia

**5.** Older adult with profound dehydration, glucose 680 mg/dL, high osmolality, and progressive confusion

Select a category
DKA
HHS
Hypoglycemia

**6.** Confusion with a glucose of 38 mg/dL that improves promptly after prescribed IV dextrose

Select a category
DKA
HHS
Hypoglycemia

## Explanation

DKA requires diabetes or glucose at least 200 mg/dL together with significant ketonemia and metabolic acidosis; euglycemic DKA may occur, especially with SGLT2 inhibitors. HHS requires marked hyperglycemia and hyperosmolality without severe ketonemia or acidosis, but mild ketonemia may be present. Hypoglycemia produces autonomic or neuroglycopenic findings that improve after glucose treatment.

## In-depth explanation

Quick answer
DKA = ketones plus acidosis; HHS = severe hyperglycemia plus hyperosmolality; hypoglycemia = low glucose with autonomic or neuroglycopenic findings.

Why this is correct
The 2024 international consensus lowered the DKA glucose threshold and emphasizes direct beta-hydroxybutyrate measurement. DKA can occur with glucose below 200 mg/dL. HHS is defined by hyperglycemia and hyperosmolality with no severe ketonemia or acidosis; saying that HHS always has no ketones is too absolute because mild ketonemia can occur.

NCLEX decision rule
Do not classify from glucose alone. Read glucose, ketones, pH or bicarbonate, osmolality, hydration, and mental status together, and recognize a possible mixed DKA-HHS presentation.Reference
1ADA/EASD/JBDS/AACE/DTS hyperglycemic-crises consensus reportDiabetes Care, 2024

## Clinical scenario

Emergency assessment
Use the current adult consensus criteria. DKA and HHS can overlap, and HHS can include mild ketonemia; classify each finding by its strongest pattern.

## Key concepts

- **Beta-Hydroxybutyrate** — The predominant circulating ketoacid in DKA and the preferred direct blood ketone measurement.
- **Hyperosmolality** — Increased concentration of osmotically active particles in blood, a defining feature of HHS.
- **neuroglycopenia** — Brain glucose deprivation causing confusion, seizure, coma in hypoglycemia.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en)
- [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en)
- [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en)
- [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=393522&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._