# Stage 4 - Generate solutions. Which actions belong in the individualized HHS plan for this older client with CKD? Select exactly 4 responses.

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Stage 4 - Generate solutions. Which actions belong in the individualized HHS plan for this older client with CKD? Select exactly 4 responses.

Select exactly 4 responses.

1

Lower osmolality rapidly by using hypotonic fluid as the default so orientation returns before further monitoring.

2

Identify and treat infection or another precipitating cause while correcting the metabolic emergency.

3

Replace potassium per protocol and delay insulin while potassium remains below 3.5 mmol/L.

4

Use the standard large-volume protocol without reassessing heart, kidney, or neurologic tolerance.

5

Give 250 mL isotonic crystalloid boluses with frequent lung, perfusion, and fluid-balance assessment.

6

Measure glucose every 1 to 2 hours; check electrolytes, creatinine, and osmolality about every 4 hours.

## Explanation

Older adults and people with kidney disease need smaller fluid boluses and frequent hemodynamic assessment, with serial glucose, electrolytes, creatinine, osmolality, and precipitant management.

## In-depth explanation

Quick answer
Build a cautious, measured, cause-directed HHS plan.

Why this is correct
The consensus report recommends cautious fluids for older or kidney-disease clients and limits osmolality decline to reduce neurologic complications.

Easy analogy or mental picture
Think of medication safety as a control panel: identify the dangerous signal, change the correct control, and verify the response.

Memory hook
Cue, action, response, reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving the continuing indication.

Why the other choices are wrong
Options that delay escalation, ignore a contraindication, or change therapy without authorization do not close the safety loop.References
12024 Consensus Report: Hyperglycemic Crises in Adults With DiabetesHHS diagnosis, cautious fluids, insulin, potassium, osmolality, renal monitoring, and resolution criteria

## Clinical scenario

Medication safety review
Verify the indication, current assessment, laboratory trend, timing, interactions, authorized action, and measurable follow-up.

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