A nurse is assessing a client post-liver transplant for signs of rejection. Which finding is most concerning?

Choice A reason: Polycystic is not a recognized symptom of HHS. The term may be confused with polycystic ovary syndrome, unrelated to HHS. HHS involves severe hyperglycemia causing dehydration, not ovarian pathology, making this sign irrelevant to the metabolic and osmotic disturbances characteristic of this condition.

Choice B reason: Polyphagia, increased hunger, is associated with HHS due to cellular glucose starvation from severe hyperglycemia. Without adequate insulin, glucose cannot enter cells, triggering hunger as the body seeks energy, making this a relevant symptom in the hyperosmolar state of HHS.

Choice C reason: Polydipsia, excessive thirst, is a hallmark of HHS. Severe hyperglycemia causes osmotic diuresis, leading to dehydration and increased plasma osmolality, stimulating the thirst center to compensate for fluid loss, making this a common and expected symptom in HHS patients.

Choice D reason: Polyuria, excessive urination, is a classic HHS symptom. High blood glucose exceeds renal reabsorption capacity, causing osmotic diuresis, which increases urine output and leads to dehydration. This is a key feature of HHS, driving fluid and electrolyte imbalances in affected patients.

Choice A reason: Contacting the provider is important but not the priority. The insulin overdose risks hypoglycemia, and immediate assessment of current glucose levels is critical to determine the patient’s status and guide interventions, as delays could worsen hypoglycemia, causing neurological or cardiovascular complications.

Choice B reason: Administering a carbohydrate snack assumes hypoglycemia without confirmation. Regular insulin peaks in 2-4 hours, and 45 minutes post-administration, glucose may not yet be critically low. Giving carbohydrates prematurely could cause hyperglycemia, making this less urgent than assessing actual glucose levels first.

Choice C reason: Completing an incident report is necessary for documentation and quality improvement but is not the priority in an acute situation. The immediate risk of hypoglycemia from excess insulin requires clinical action to assess and stabilize the patient before addressing administrative tasks.

Choice D reason: Checking blood glucose is the priority, as excess regular insulin risks hypoglycemia, especially in type 1 diabetes with no endogenous insulin reserve. Knowing the current glucose level guides interventions, preventing seizures or unconsciousness, and ensures timely correction of potential hypoglycemia or other metabolic imbalances.