A nurse carefully assesses a patient with hyperglycemic hyperosmolar syndrome (HHS). Which sign is most likely NOT associated?

Choice A reason: A mild fever of 100.4°F may indicate infection or early rejection post-liver transplant but is less specific than liver enzyme elevation. Fever is common post-surgery and requires monitoring, but it does not directly confirm rejection, making it less concerning than enzyme changes.

Choice B reason: Elevated liver enzymes (e.g., AST, ALT) are a primary indicator of liver transplant rejection, reflecting hepatocyte damage from immune-mediated attack. This requires urgent evaluation and possible immunosuppression adjustment to prevent graft failure, making it the most concerning finding in this context.

Choice C reason: Increased urine output is not associated with liver transplant rejection. It may indicate adequate hydration or diuretic effects but does not reflect liver function or immune response, making it an irrelevant finding for assessing rejection in a post-transplant patient.

Choice D reason: Stable blood pressure is normal and not indicative of rejection. Rejection affects liver function, causing enzyme elevation or jaundice, not hemodynamic changes. Stable blood pressure suggests cardiovascular stability, making this finding unremarkable in the context of assessing transplant rejection.

Choice A reason: Not checking blood sugar before exercise is dangerous for diabetic patients, as hypoglycemia can occur during physical activity due to increased glucose uptake by muscles. Monitoring ensures safe exercise, preventing severe hypoglycemia, which can cause seizures or unconsciousness, requiring immediate correction with glucose sources.

Choice B reason: Eating a snack if blood sugar is below 100 mg/dL before exercise is appropriate. Low blood sugar increases hypoglycemia risk during activity due to enhanced insulin sensitivity and glucose utilization. A carbohydrate snack stabilizes glucose levels, ensuring safe exercise and preventing adverse events.

Choice C reason: Carrying hard candy is a correct practice for diabetic patients to quickly treat hypoglycemia during exercise. Hard candy provides rapid-acting glucose, counteracting low blood sugar caused by increased muscle glucose uptake or insulin effects, preventing symptoms like shakiness or confusion.

Choice D reason: Including swimming as an exercise routine is appropriate for diabetes management. Aererobic exercise like swimming enhances insulin sensitivity, promotes glucose uptake by muscles, and improves cardiovascular health, helping maintain stable blood sugar levels without increasing hypoglycemia risk when properly monitored.