# A 74-year-old client with type 2 diabetes and stage 3 chronic kidney disease presents with drowsiness, dry mucous membranes, BP 92/54 mm Hg, glucose 824 mg/dL, effective osmolality 326 mOsm/kg, potassium 3.4 mmol/L, and creatinine 2.3 mg/dL from 1.4 mg/dL. Classify each finding by the treatment decision it most directly supports. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=522067&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 presents with drowsiness, dry mucous membranes, BP 92/54 mm Hg, glucose 824 mg/dL, effective osmolality 326 mOsm/kg, potassium 3.4 mmol/L, and creatinine 2.3 mg/dL from 1.4 mg/dL. Classify each finding by the treatment decision it most directly supports. | | Supports initial fluid replacement | Changes insulin or potassium safety | Requires controlled osmolality correction | | --- | --- | --- | --- | | BP 92/54 mm Hg with dry mucous membranes | | | | | Potassium is 3.4 mmol/L | | | | | Creatinine is 2.3 mg/dL from 1.4 mg/dL | | | | | Effective osmolality is 326 mOsm/kg | | | | | The client is drowsy and disoriented | | | | ## Explanation Hypotension and dehydration support cautious fluid replacement; potassium 3.4 mmol/L and acute kidney injury change potassium and insulin safety; osmolality and cognition require controlled correction and frequent neurologic reassessment. ## In-depth explanation Quick answer Sort the cues into perfusion, electrolyte-insulin safety, and controlled osmolality correction. Why this is correct HHS decisions are linked: fluids restore perfusion and renal glucose clearance, potassium below 3.5 mmol/L delays insulin, renal impairment narrows replacement tolerance, and osmolality plus cognition determine correction-rate safety. 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 Perfusion, potassium, osmolality: classify by the decision each cue changes. NCLEX decision rule A cue may support more than one decision when it changes both circulation and medication safety. Why the other choices are wrong Treating the glucose value in isolation misses hypovolemia, potassium shift, kidney injury, and neurologic risk.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 cue classification Connect each assessment finding to the specific fluid, potassium, insulin, or correction-rate decision it changes. ## 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=522067&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522067&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._