# A 74-year-old client with type 2 diabetes and stage 3 chronic kidney disease has fever and poor intake for 3 days and is now drowsy. Highlight the findings in the emergency record that support hyperosmolar hyperglycemic state and directly affect immediate treatment safety. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=522066&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## Question A 74-year-old client with type 2 diabetes and stage 3 chronic kidney disease has fever and poor intake for 3 days and is now drowsy. Highlight the findings in the emergency record that support hyperosmolar hyperglycemic state and directly affect immediate treatment safety. Emergency Record A 74-year-old client with type 2 diabetes and stage 3 chronic kidney disease has had fever and poor intake for 3 days. The client is drowsy and disoriented, with dry mucous membranes, BP 92/54 mm Hg, HR 112/min, glucose 824 mg/dL, effective serum osmolality 326 mOsm/kg, potassium 3.4 mmol/L, pH 7.36, beta-hydroxybutyrate 1.2 mmol/L, creatinine 2.3 mg/dL, baseline 1.4 mg/dL, and SpO2 97 percent on room air. ## Explanation Severe hyperglycemia, effective osmolality above 300 mOsm/kg, dehydration with hypotension, altered cognition, potassium 3.4 mmol/L, and acute kidney injury support HHS and change the initial fluid, potassium, and insulin plan. ## In-depth explanation Quick answer Recognize HHS with hypovolemia, treatment-sensitive hypokalemia, and renal vulnerability. Why this is correct The glucose and osmolality meet the hyperglycemic-hyperosmolar pattern, while pH 7.36 and beta-hydroxybutyrate 1.2 mmol/L argue against substantial ketoacidosis. Hypotension, cognitive change, potassium 3.4 mmol/L, and acute kidney injury determine how cautiously treatment begins. Easy analogy or mental picture Treat HHS like restoring a concentrated circulation system: refill carefully, protect potassium, then lower glucose and osmolality at a controlled rate. Memory hook HHS: volume first, potassium protected, osmolality controlled. NCLEX decision rule Highlight cues that either establish HHS or immediately change fluid, potassium, or insulin safety; do not select every abnormal value simply because it is abnormal. Why the other choices are wrong A near-normal pH and low ketone level help distinguish HHS from DKA, while a normal oxygen saturation does not guide the metabolic treatment sequence.References 12024 Consensus Report: Hyperglycemic Crises in Adults With DiabetesHHS diagnosis, cautious fluids, potassium and insulin safety, controlled osmolality correction, and resolution criteria ## Clinical scenario HHS recognition and treatment safety Identify diagnostic cues together with perfusion, potassium, renal, and neurologic findings that alter the first treatment phase. ## Related questions - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en) - [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en) - [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=en) - [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=en) - [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522066&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522066&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522066&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522066&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522066&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._